Angioma serpiginosum

A 14-year-old female presented to our outpatient department with a 5-day history of sudden onset of multiple well-defined, discrete to confluent, punctate, reddish-purple macules and papules on the anterior aspect of the left thigh [Figure 1]. On diascopy, lesions were non-blanchable. Dermoscopy showed multiple well-demarcated, round to oval reddish-purple lagoons arranged in a serpiginous pattern [Figure 2]. Histopathology [Figure 3] revealed multiple dilated, thin- walled capillaries in the papillary dermis filled with red blood cells. Hence, based on clinical, dermoscopic, and histopathologic features, a diagnosis of Angioma serpiginosum was made.

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Figure 1:

Reddish purple macules and papules on the anterior aspect of the left thigh.

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Figure 2:

Dermoscopy showing round-to-oval reddish-purple lagoons (orange circles) arranged in a serpiginous pattern (orange arrows). Image obtained using a DermLite DL4 at 10× magnification, polarized white light, contact mode without immersion fluid.

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Figure 3:

Skin biopsy specimen on higher magnification showing dilated thin-walled capillaries (orange arrows) in the papillary dermis filled with red blood cells (orange circles) (H&E, ×40; scale bar = 50 μm). H&E: Hematoxylin and eosin.

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Angioma serpiginosum is a rare, benign, acquired, vascular condition presenting as violaceous to coppery red maculopapular eruptions arranged in a linear, gyrate, or serpiginous pattern on an erythematous background.^[1] It has a female preponderance and mainly affects the lower extremities and buttocks.^[2] These asymptomatic progressive lesions usually start in early childhood and stabilise in adults. Some common differential diagnoses include capillary hemangioma, angiokeratomas, unilateral nevoid telangiectasia, pigmented purpuric dermatoses, capillary malformation, and port wine stain.^[3] Angioma serpiginosum is limited to the skin, but sometimes, the ocular and nervous system may be involved.^[3] The lesions do not resolve spontaneously; the treatment options can be tried to minimize the appearance of the lesions and improve cosmetic outcomes. Lasers such as argon laser, pulsed dye laser, or intense pulsed light, may show promising results in terms of clearance of lesions.^[2] However, the effectiveness of laser therapies varies among individuals, and multiple sessions may be required to achieve the desired improvement.