In the past decades, there was a considerable advance in regard to recognition of morphologic findings and classification of several benign and malignant vascular proliferations. In 2002, attention was called by Requena et al to a new variant of cutaneous hemangioma named acquired elastotic hemangioma. In this article, a case of acquired elastotic hemangioma is reported with documentation of clinical, dermatoscopic, histopathological, and immunohistochemical findings. A systematic review of the previously 49 reported cases is provided. The criteria for clinical and histopathological diagnosis are highlighted.

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alcohol. 1 With a total of ten cases reported in literature by now, we considered relevant to report another case we recently came across.A 55-year-old woman with 3-year history of cryptogenic cirrhosis was admitted to our Dermatology service because of the appearance of abdominal pruriginous lesions for the past 2 months. Clinical examination revealed yellowish confluent weals affecting her abdomen and flanks (Figs 1 and 2). Blood tests revealed hyperbilirubinemia. She was diagnosed with idiopathic yellow urticaria and was given antihistamines with clearance of the rash and symptoms, without scarring.The cause of yellow urticaria remains unknown, but it is suggested to be the result of increased blood vessels permeability due to capillary vasodilation, as described in common urticaria, and accumulation of excessive bilirubin into the surrounding dermis, responsible of the yellow colour of the skin. 2 The oedema fluid associated with urticaria in patients with jaundice may appear yellow because of hyperbilirubinemia. 3 Most reported cases were related to chronic hepatic dysfunction (endstage liver disease, metastatic disease of breast and colon, hepatic cirrhosis associated with alcohol, virus, haemochromatosis). 1,[3][4][5][6][7][8] Only one case was related to cholestasis in a patient with acute hepatic dysfunction due to haemorrhagic shock. 2 Liver dysfunction is characterized by a decrease in the capacity to conjugate bilirubin, with several other problems as dyscrasia. This impairs the normal process of excretion of bilirubin, with consequent bilirubin crystal deposition in tissues. 5 The jaundice may persist for several days, despite a normalized bilirubin, due to its affinity for elastin. 5 The diagnosis is clinical and does not require histopathological examination. Nevertheless, some of the reported cases demonstrated mild dermic oedema and perivascular inflammatory infiltrate composed of lymphocytes, neutrophils and eosinophils. 3,5 Dermic deposition of bilirubin crystals was demonstrated in one case. 3 Treatment is the same of acute urticaria and includes antihistamines and steroids. 1 Although yellow urticaria is an exceptional event, we can assert that it could be the only scenario in which aetiology of urticaria can be intuited on the basis of the clinical morphology.