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(A) Grouped, punctate, erythematous macules on the left sole. (B) Similar lesions on toes. (C) Close-up view of the lesions on left sole.
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Figure 1: (A) Grouped, punctate, erythematous macules on the left sole. (B) Similar lesions on toes. (C) Close-up view of the lesions on left sole.

Mentions: She was referred to a dermatologist, and the examination revealed multiple grouped, nonblanchable, red to violaceous macules on an erythematous background extending from the left sole to the toes (Figs. 1A, B, and C). On close examination with a hand lens, the blood contents of the lesions were clearly within capillary loops without evidence of hemosiderin deposition. A skin biopsy specimen revealed hyperkeratosis and many dilated and proliferated capillaries in the papillary dermis. No significant inflammatory cell infiltration or red blood cell extravasation was seen (Figs. 2A and B). Estrogen and progesterone receptors were negative. Correlation of the clinical and histological findings resulted in the diagnosis of angioma serpiginosum.

Atypical Angioma Serpiginosum

Chen JH, Wang KH, Hu CH, Chiu JS - Yonsei Med. J. (2008)

Bottom Line: Histopathological examination showed hyperkeratosis and multiple dilated and proliferated capillaries in the papillary dermis.Inflammation and extravasation of red blood cells were not found.She was treated with a pulsed dye laser, and the angiomatous lesions subsequently improved.

Affiliation: Department of Dermatology, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.

ABSTRACT
Angioma serpiginosum is an uncommon, acquired vascular nevoid disorder with capillary dilation and proliferation in the papillary dermis. The eruptions are asymptomatic and characterized by grouped, erythematous to violaceous, serpiginous and punctate macules. The condition usually appears in females during adolescence on unilateral lower extremities and the buttocks. We report a rare case with a late onset and atypical distribution of lesions in a 48-year-old female patient who had groups of punctate lesions on her left foot for four to five years. Histopathological examination showed hyperkeratosis and multiple dilated and proliferated capillaries in the papillary dermis. Inflammation and extravasation of red blood cells were not found. According to the clinical and pathological findings, we established a diagnosis of angioma serpiginosum. She was treated with a pulsed dye laser, and the angiomatous lesions subsequently improved.

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