Telangiectasias on the Lower Extremity

Abstract

A woman in her 80s presented with a 1-year history of blanchable, salmon-colored, monomorphic macules and fine telangiectasias localized to her right lower leg (Figure , A). The asymptomatic patch had slowly enlarged since initial onset, but remained confined to the single extremity. Physical examination revealed agminated and discrete erythematous macules as well as interspersed fine, reticulated telangiectases over the right pretibial leg (Figure , B). No edema or warmth of the affected area was observed, and there was no evidence of mucosal, conjunctival, or nail involvement. Findings on review of systems were negative for bleeding tendencies or hypercoagulability. A punch biopsy was performed (Figure , C and D). Diagnosis C. Cutaneous collagenous vasculopathy (CCV) Microscopic Findings and Clinical CourseHistopathologic examination demonstrated the presence of multiple dilated, thin-walled capillaries located within the papillary dermis. The vessel walls were surrounded by thick, concentric depositions of pink hyaline material (Figure , C) that was highlighted with periodic acid-Schiff (PAS) stain (Figure, D). No fibrin thrombi or vasculitis was identified. Congo red staining was negative for amyloid. These clinicopathologic findings are consistent with CCV. DiscussionCutaneous collagenous vasculopathy is a distinct form of idiopathic, primary cutaneous microangiopathy, affecting superficial dermal blood vessels. Clinically, CCV presents as asymptomatic, Clinical view A Close clinical view B Hematoxylin-eosin stain C Periodic acid-Schiff stain D Figure. A, Reticulated, blanchable, salmon-colored patch on the pretibial leg. B, Individual fine, telangiectatic erythematous macules identified on closer inspection. C, Concentric deposits of hyaline material surround dilated and markedly thickened capillaries within the papillary dermis (original magnification ×200). D, Perivascular hyaline deposits are highlighted strongly by periodic acid-Schiff stain (original magnification ×200). WHAT IS YOUR DIAGNOSIS? A. Essential telangiectasia B. Leukocytoclastic vasculitis C. Cutaneouscollagenousvasculopathy D. Pigmented purpuric dermatosis, Schamberg type Clinical Review & Education