DrMihm.com Case File

 Search Dr.Mihm.com
 

Angioma Serpiginosum - Submitted on: Monday July, 30, 2001
Contributed by:Artur Zembowicz, MD PhD., Dorota Markiewicz, MD
Angioma Serpiginosum (AS) was first described in 1889 by Hutchinson as a form of serpiginous and possibly infective nevoid disease. Currently AS is considered to be a type of capillary nevus composed by proliferating papillary dermal capillaries and not a simple telangiectasia of pre-existing vessels.

Definition:
AS is a rare nevoid vascular malformation that usually occurs in the papillary and superficial dermis with no evidence of inflammation, hemorrhage or pigmentation.

Clinical Features:
AS is an asymptomatic macular eruption with multiple, minute, red to purple grouped puncta which enlarge to form a serpiginous and gyrate pattern over the period of months to years. After an initial period of growth before puberty the lesions usually remain stable in the adult life and sometimes completely or partially spontaneously regress. AS affects most commonly young females. It can occur at any site. Lower extremities are the sites of predilection. Mucous membranes, palms and soles are typically spared.

Histology:
Figures
(Click on an image for a larger view)
Figure 1a
Figure 1b
Increased numbers of dilated capillaries are present in the papillary dermis. The overlying epidermis is normal. Inflammation, red cells extravasation and hemosiderin are absent. (Figures 1A and 1B)
Electron microscopic examination shows the dilated, thick-walled capillaries consisting of endothelial cells, pericytes and veil cells. Thickening of capillary walls caused by the precipitate of basement membrane-like material (an inner layer) and thin collagen fibers (an outer layer) can sometimes be noted.


Treatment:
Laser therapy is the most effective mode of treatment of AS.

Bibliography:
  • Barnhill RL Textbook of dermatopathology; McGraw- Hill 1998;690;
  • Elder D. Leverís Histopathology of the skin; Lippincott- Raven 1999,900;
  • Katta R, Wagner A Angioma serpiginosum with extensive cutaneous involvement. J Am Acad Dermatol 2000 Feb;42(2 Pt 2):384-5;
  • Raquena L., Sagueza P. Cutaneous vascular proliferations. Part II. J Am Acad of Dermatology Dec 1997;vol 37(6), 887-920;
  • Yaffee HS. Angioma serpiginosum Arch Dermatol 1967;95:667
  • Long CC, Lanigan SW Treatment of angioma serpiginosum using a pulsed tunable dye laser. Br J Dermatol 1997 Apr;136(4):631-2;
  • Kumakiri M, Katoh N, Miura Y Angioma serpiginosum. J Cutan Pathol 1980 Dec;7(6):410-21;
  • Whyte MP Angiokeratoma serpiginosum. Int J Dermatol 1978 Dec;17(10):793-8;
  • Marriott PJ, Munro DD, Ryan T Angioma serpiginosum--familial incidence. Br J Dermatol 1975 Dec;93(6):701-6;
     

    Back To Cases

     


    [Home] [Observations] [Cases] [Glossary] [Who We Are] [Contact Us] [Links] [Search]


     

    Copyright © 2001-2002 Martin C. Mihm, Jr.
    All  rights reserved worldwide.