Dermoscopy of angioma serpiginosum: a case report

Dermoscopic profile of pigmented purpuric dermatosis: new observations

Introduction

Pigmented purpuric dermatosis (PPD) describes a cutaneous eruption that presents with asymptomatic or pruritic macules, and petechiae with red and brown pigmentation. Dermoscopy is a non-invasive diagnostic method making a more detailed examination possible and provides important clues to many dermatologic conditions. There are few original studies focusing on the dermoscopic aspect of PPD apart from case reports.

Aim

To identify dermoscopic findings of pigmented purpuric dermatosis, which will facilitate diagnosis by reducing the use of invasive procedures.

Material and methods

The study included the patients with histopathologically confirmed pigmented purpuric dermatosis. Demographic, clinical and dermoscopic features of all the cases were retrospectively reviewed.

Results

The study enrolled 15 (60%) men and 10 (40%) women. The mean age of the patients was 42 (age range: 28–72). The most common dermoscopic findings were red globules and red dots which were observed in all the cases (100%), followed by coppery brown background (72%), brown lines reticular (40%) and subtle brown dots (40%). The other findings were brown circles (32%), red circles (32%), grey dots (32%), red background (8%), serpentine vessels (8%), rosette structures (8%), thick brown lines (4%), and thick linear vessels (4%).

Conclusions

The characteristic dermoscopic findings of PPD have been defined in the relevant literature. Here we have identified some dermoscopic findings which have not been described previously: red circles, brown circles, rosette structures, light brown background and red background. Dermoscopic examination may facilitate the diagnostic process by reducing the use of invasive methods.

Angioma serpiginosum: a case report and review of the literature

Background

Angioma serpiginosum is a rare vascular anomaly whose pathogenesis is still unknown. It is characterized by the onset of vascular reddish macules and papules during childhood, lesions are usually monolateral with a linear serpiginous pattern. It is rarely associated with extracutaneous findings. This entity has not yet been included in the classification of the International Society for the Study of Vascular Anomalies.

Case presentation

We describe the first Italian report of angioma serpiginosum with a congenital symmetrical presentation. The patient had a further extension of macules during puberty involving both of the soles. No extracutaneous manifestations were present. Diagnosis was confirmed with dermoscopy and light microscopy that revealed the typical clusters of dilated, thickened and PAS+ capillaries in the upper dermis. Moreover, Immunohistochemistry showed positive WT-1 staining. Genetic analysis with next generation sequencing did not detected any mutation.

Conclusions

Our patient presented a peculiar symmetrical and planar extension with a serpiginous linear pattern. The proliferative nature of this condition has been widely discussed in literature. In our case immunohistochemistry was positive for Wilms tumor-1, a new endothelial marker expressed during angiogenesis in reparative processes and endothelial tumors.

Clinical evolution, histological and immunohistochemical findings suggest that angioma serpiginosum should be considered as a vascular proliferation. For these reasons we think it should be included in the international classification as a tumor.

Angioma serpiginosum: report of an unusual acral case and review of the literature

We report the case of a 35-year-old woman with deep-red asymptomatic macules on the plantar and dorsal skin of the right great toe. Histopathologic fi ndings were compatible with Angioma serpiginosum. Immunohistochemical stains for estrogens and progesterone receptors were negative. Dermoscopy showed an erythematous parallel ridge pattern with double rows of irregular dots and globules. We report an unusual case of angioma serpiginosum with acral volar skin involvement. The dermoscopic features described may aid in the diagnosis of AS in this specifi c skin area. Acral volar skin involvement must be included in the clinical spectrum of Angioma serpiginosum and in the differential diagnosis of acral vascular lesions.