Unusual vascular rash to trunk and extremities

Presenter: Laura F. Sandoval, DO, Jonathan S. Crane, DO
Dermatology Program: Sampson Regional Medical Center
Program Director: Jonathan S. Crane, DO
Submitted on: Aug 1, 2015

CHIEF COMPLAINT:  A 65 year old male was referred by a vascular surgeon for a rash on his trunk and upper and lower extremities.

CLINICAL HISTORY:

Signs and symptoms:  The patient was being worked up for possible treatment of venous insufficiency of the lower extremities and the rash was of concern prior to any venous ablation procedures. The rash was present for 40 years and was asymptomatic.

PHYSICAL EXAM:

On physical exam, widespread patches of telangiectasia were present symmetrically on the abdomen, low back, arms, thighs and knees. (Figures 1-2)

Figure 1
Figure 2

LABORATORY TESTS:

None

DERMATOHISTOPATHOLOGY:

A 4-mm punch biopsy was obtained and showed dilated, thick-walled vessels without significant hemorrhage or inflammation within the superficial dermis. The vessel walls contain amorphous, hyaline pink material that stains positive with PAS stain. (Figures 3-5)

Figure 3
Figure 4
Figure 5

DIFFERENTIAL DIAGNOSIS:

1.   Generalized essential telangiectasia
2.   Cutaneous Collagenous Vasculopathy
3.   Hereditary benign telangiectasia


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