Diffuse dermal angiomatosis (DDA) is a rare, acquired, reactive vascular proliferation, clinically characterized by livedoid erythematous–violaceous plaques, which frequently evolve to ulceration and necrosis. Histopathologically, it is manifested by a diffuse proliferation of endothelial cells within the full thickness of the dermis. DDA has been mainly associated with severe peripheral atherosclerosis.
We report a 63-year-old woman who presented with multiple erythematous–violaceous plaques with central deep skin ulcers on thighs, lower abdomen, and perianal area, associated with intermittent claudication, low-grade fever, and weight loss. Initially, the clinical picture along with positive cultures for Klebsiella pneumoniae suggested a multifocal ecthyma gangrenosum; nevertheless, a skin biopsy showed a diffuse dermal proliferation of endothelial cells interstitially arranged between collagen bundles. A computed tomography scan revealed severe aortic atheromatosis with complete luminal occlusion of the infrarenal aorta and common iliac arteries.
The diagnosis of DDA secondary to severe atherosclerosis was established. The patient underwent a left axillofemoral bypass surgery with a rapidly healing of the ulcers in the next weeks.
DDA should be considered in the differential diagnosis of livedoid ischemic lesions. Recognition of DDA as a cutaneous sign of severe peripheral vascular disease is important for both dermatologists and internists. Recognition of risk factors and their management with an early intervention to correct tissue ischemia can be curative.
aDepartment of Dermatology
bDepartment of Vascular Surgery
cDepartment of Pathology
dDepartment of Infectious Diseases, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Correspondence: Lidia García-Colmenero, Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25–29, Barcelona, Spain (e-mail: firstname.lastname@example.org).
Abbreviations: CRA = cutaneous reactive angiomatoses, CT = computed tomography, DDA = diffuse dermal angiomatosis, DSA = digital subtraction angiography, VEGF = vascular endothelial growth factor.
Informed Consent: The patient provided her informed consent for the publication of this case report.
The authors have no conflict of interest to disclose.
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Received February 8, 2016
Received in revised form May 10, 2016
Accepted June 20, 2016