Angioma Serpiginosum

OBSERVATION
Angioma Serpiginosum
A Report of 2 Cases Identified Using Epiluminescence Microscopy
Takamitsu Ohnishi, MD, PhD; Takashi Nagayama, MD; Takashi Morita, MD;
Takako Miyazaki, MD; Hiroyuki Okada, MD; Kuniaki Ohara, MD; Shinichi Watanabe, MD, PhD
Background: Angioma serpiginosum is a rare, ac-
served entirely or focally in these 2 cases, but not in 4 cases
quired vascular lesion simulating purpura, and should
of Henoch-Scho¨nlein purpura and a case of senile purpura.
be differentiated from purpuric dermatoses such as He-
noch-Scho¨nlein purpura.
Conclusion: Epiluminescence microscopy is beneficial
in distinguishing angioma serpiginosum from purpuric
Observations: We report 2 cases of angioma serpigino-
dermatoses.
sum examined using epiluminescence microscopy. Char-
acteristic findings of angiomas (“red lagoons”) were ob-
Arch Dermatol. 1999;135:1366-1368
ANGIOMAserpiginosum tionspresentatbirth.Theygraduallymul-
is a rare acquired vascular
tiplied with no symptomatic sign until
disorder that manifests
about age 7 years. The patient’s medical
clinically as numerous
and family histories were unremarkable.
punctate erythemas that
Findings of physical examination in-
simulate purpura. Therefore, it is some-
cluded numerous punctate erythemas on
times difficult to distinguish from purpu-
the lateral portion of the leg from the right
ric dermatoses such as Henoch-Scho¨nlein
knee to the lower leg, some of which were
purpura. We report 2 cases of angioma
grouped (Figure 2). The eruptions did
serpiginosum diagnosed using epilumi-
not disappear under diascopy.
nescence microscopy.
HISTOPATHOLOGIC FINDINGS
REPORT OF CASES
The results of histopathologic examina-
tions in both cases revealed dilated, thin-
CASE 1
walled capillaries in the dermal papillae
A 21-year-old woman came to our depart-
and superficial reticular dermis. There was
ment in October 1998 with an asymptom-
no extravasation of red blood cells and no
atic eruption on her knee that had been
perivascular inflammatory infiltration
noticed about 5 years previously. The le-
(Figure 3).
sion had not grown or multiplied since that
time. The patient’s medical and family his-
RESULTS
tories were unremarkable. The findings of
physical examination included numer-
In case 1 the condition manifested en-
ous punctate, dark red erythemas around
tirely as numerous small, red, sharply de-
her right knee that did not disappear un-
marcated lagoons (Figure 4). In case 2,
der the pressure of diascopy (Figure 1).
the results of epiluminescence micros-
copy showed relatively well-demarcated
From the Departments of
CASE 2
round to oval red patches, including the
Dermatology, Teikyo
typical red lagoon (Figure 5). In the 4
University School of Medicine
In August 1998, a 15-year-old boy pre-
cases of Henoch-Scho¨nlein purpura and
(Drs Ohnishi, Nagayama,
sented with punctate eruptions on his right
a case of senile purpura, however, the erup-
Morita, Miyazaki, Okada, and
Watanabe) and Toranomon
lower extremity. His parents had first no-
tions consisted of irregularly shaped red
Hospital (Dr Ohara),
ticed the eruptions about 4 months after
patches with blurred borders; no lagoon
Tokyo, Japan.
his birth, although there were no erup-
was observed.
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METHODS
The eruptions were evaluated in vivo with application
of Echo Gel (Nikko Fine Industries Co Ltd, Tokyo,
Japan) using a Dermatoscope Delta 10 (Heine Opto-
technik,Herrsching,Germany),andwerephotographed
using Dermaphoto (Heine Optotechnik, Herrsching,
Germany). For comparison, 4 cases of Henoch-
Scho¨nlein purpura (histologically confirmed as leu-
kocytoclastic vasculitis) were analyzed by the same pro-
cedure. A case of senile purpura was also examined.
Figure 3. Case 2. Histopathologic findings. Of note is the dilated, thin-walled
capillary in the dermal papilla (hematoxylin-eosin, original magnification ?50).
Figure 1. Case 1. Numerous punctate, dark red erythemas are present
around the knee and do not disappear under the pressure of diascopy.
Figure 4. Case 1. Epiluminescence microscopy findings. The eruptions
consist exclusively of numerous small, red, sharply demarcated lagoons.
Figure 2. Case 2. Numerous punctate erythemas, some of which are
Figure 5. Case 2. Epiluminescence microscopic findings. Relatively
grouped on the lateral region of the lower extremity.
well-demarcated round to oval red patches, including the typical red lagoons.
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COMMENT
well as other hemangiomas; there were no lagoons in the
5 cases of purpuric lesions. Therefore, epiluminescence
Angioma serpiginosum is characterized by erythema-
microscopy is beneficial in distinguishing angioma ser-
tous punctate lesions that do not disappear under dias-
piginosum from purpuric dermatoses.
copy.1 Because the lesion simulates purpura, differentia-
tion from purpuric dermatoses such as Henoch-
Accepted for publication June 24, 1999.
Scho¨nlein purpura is important, and it is sometimes
Reprints: Takamitsu Ohnishi, MD, Department of Der-
difficult to distinguish them by clinical appearance alone.
matology, Teikyo University School of Medicine, 11-1,
Therefore, the patient with angioma serpiginosum tends
Kaga-2, Itabashi-ku, Tokyo 173-8605, Japan (e-mail:
to undergo unnecessary hematological tests for the in-
ohnishi@med.teikyo-u.ac.jp).
vestigation of purpura.2
Epiluminescence microscopy is a nonstressful pro-
REFERENCES
cedure for evaluating colored lesions of the skin surface.
There have been many investigations concerning mela-
1. Barker LP, Sachs PM. Angioma serpiginosum. Arch Dermatol. 1965;92:613-
nocytic lesions,3 especially malignant melanoma.4 How-
620.
ever, the procedure is also useful for evaluating vascular
2. Cox NH, Paterson WD. Angioma serpiginosum: a simulator of purpura. Post-
lesions. Typical findings, ie, demarcated red lagoons due
grad Med J. 1991;67:1065-1066.
3. Argenziano G, Fabbrocini G, Carli P, De Giorgi V, Sammarco E, Delfino M. Epi-
to dilated vascular spaces within the papillary or superfi-
luminescence microscopy for the diagnosis of doubtful melanocytic skin le-
cial reticular dermis, occur in hemangiomas, predomi-
sions. Arch Dermatol. 1998;134:1563-1570.
nantly in eruptive hemangiomas and angiokeratomas.5 To
4. Menzies SW, Ingvar C, Crotty KA, McCarthy WH. Frequency and morphologic
the best of our knowledge, there is no report of epilumi-
characteristics of invasive melanomas lacking specific surface microscopic fea-
tures. Arch Dermatol. 1996;132:1178-1182.
nescence microscopy being used to evaluate angioma ser-
5. Stolz W, Falco OB, Bilek P, Landthaler M, Cognetta AB. Dermatoscopic criteria.
piginosum. The eruptions in case 1 consisted entirely of
In: Stolz W, Falco OB, Bilek P, Landthaler M, Cognetta AB, eds. Color Atlas of
red lagoons, and those in case 2 included red lagoons as
Dermatoscopy. Oxford, England: Blackwell Publishers; 1994:11-36.
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