Generalized essential telangiectasia is a rare cutaneous disorder with limited therapeutic options. To evaluate the treatment with high-energy, high-frequency, long-pulse Nd:YAG laser in a patient with generalized essential telangiectasia. A 62-year-old woman presented with a 20-year history of generalized essential telangiectasia. She had extensive telangiectasias primarily on the forearms and lower legs. The patient was treated with an Nd:YAG laser using a fluence of 20 J/cm2 and a pulse width of 20 msec. A sapphire water-cooled chill tip was used to cool the skin during laser therapy. The treatment was performed every 4 weeks over a period of 6 months. After six treatment sessions an almost complete clearance of telangiectatic lesions was observed. Side effects such as purpura, scarring, and pain did not occur. After a follow-up of 6 months, small telangiectatic lesions relapsed. Our results suggest that the Nd:YAG laser appears to be an effective and safe treatment option for generalized essential telangiectasia.