|Year : 2020 | Volume
| Issue : 1 | Page : 45-46
Angiokeratoma circumscriptum of children: A case of postinjury with a lesion on the foot
Liuchang Tan, Xinying Li, Yuangang Lu
Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, Chongqing, China
|Date of Submission||11-Jun-2019|
|Date of Decision||23-Oct-2019|
|Date of Acceptance||27-Nov-2019|
|Date of Web Publication||24-Dec-2019|
Dr Yuangang Lu
Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing 400042
Source of Support: None, Conflict of Interest: None
Angiokeratoma circumscriptum vascular lesions are defined by ectasia of the papillary dermal vessels, and the etiology is unknown. We report a rare case of angiokeratoma circumscriptum following the excision of a lipoma, from the same area, on the right foot 3 years prior. Therefore, this case indicates that the injury could be involved in the development of angiokeratoma circumscriptum.
Keywords: Angiokeratoma, angiokeratoma circumscriptum, Post injury angiokeratoma
|How to cite this article:|
Tan L, Li X, Lu Y. Angiokeratoma circumscriptum of children: A case of postinjury with a lesion on the foot. Indian J Paediatr Dermatol 2020;21:45-6
|How to cite this URL:|
Tan L, Li X, Lu Y. Angiokeratoma circumscriptum of children: A case of postinjury with a lesion on the foot. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 Feb 19];21:45-6. Available from: http://www.ijpd.in/text.asp?2020/21/1/45/273834
Author Liuchang Tan and Xinying Li contributed equally to this work
| Introduction|| |
Since the first description of angiokeratomas in 1890, angiokeratomas can be classified into five types: (1) angiokeratoma of Mibelli; (2) angiokeratoma of Fordyce; (3) angiokeratoma corporis diffusum; (4) angiokeratoma circumscriptum; and (5) solitary or multiple angiokeratomas., Angiokeratoma circumscriptum was first described by Fabry in 1915, which is the least frequent among the five types of angiokeratomas, and the etiology is unknown, and its lesions are usually present at birth and may be associated with cavernous hemangioma, nevus flammeus, or hemangiectic hypertrophy.
| Case Report|| |
A 5-year-old Chinese child presented with a 1-year history of plaques and red to black-colored papules on the right foot. The child accepted the excision of a lipoma on the same area 3 years ago. Examination revealed plaques and black-colored papules, measuring 0.2–10 mm, forming a coalescent plaque predominantly on the medial malleolus of the right foot [Figure 1]. Initially, the lesion was small red plaque confined to the excision scar. Subsequently, the plaque areas became hyperkeratotic with age. The lesion was asymptomatic except for symptom of pruritus. There was no relevant family history. A dermoscopic pattern presented by dark lacunae, whitish veil, and peripheral erythema with hemorrhagic crust [Figure 2]. The biopsy specimen from a representative papule showed dilated thin-walled capillary capillaries with hyperkeratosis and acanthosis [Figure 3]. According to the clinical and histopathological features, angiokeratoma circumscriptum was diagnosed. No recurrence has been observed during a 6 months' follow-up period after treated with an intense pulse light source.
|Figure 1: Plaques and black-colored papules forming a coalescent plaque predominantly on the medial malleolus of the right foot|
Click here to view
|Figure 2: (a) A dermoscopic pattern presented by dark lacunae, a whitish veil, and peripheral erythema with a hemorrhagic crust. Dilated vascular spaces in the papillary dermis with thrombosis presented as dark lacunae. Hyperkeratosis and acanthosis appeared as a whitish veil. (b) In the dermoscopic view, the presence of well-demarcated, round, and dark lacunae which histologically represent dilated vessels with thrombosis|
Click here to view
|Figure 3: Histopathology showing hyperkeratosis acanthosis. Papillary dermis showing dilated blood-filled vessels (H and E, ×100)|
Click here to view
| Discussion|| |
Angiokeratoma circumscriptum is typically situated on the lower legs or feet in a unilateral or otherwise asymmetrical distribution involving the thighs, buttocks, trunk or occasionally other areas. Clinically, angiokeratoma circumscriptum is characterized by aggregates of hyperkeratotic erythematous papules (deep red to blue–black in color) and nodules, which may coalesce to form verrucous plaques. The lesions become increasingly studded with warty keratotic papules or nodules. There is no tendency to spontaneous regression.
Angiokeratoma circumscriptum is often misdiagnosed as verrucous hemangioma, Cobb syndrome, angioma serpiginosum, lymphangioma circumscriptum, verrucae, malignant melanoma. However, in the dermoscopic view, these above lesions hardly show whitish veils. Dermatoscopy is useful for the diagnosis of angiokeratoma.
Angiokeratoma circumscriptum's histopathology consist of dilated, thin-walled, congested papillary dermal vessels with secondary epidermal reaction changes, such as acanthosis and/or hyperkeratosis, without involvement of the deep dermis, which are thought to be a vascular lesion arising from local damage of papillary capillaries.
The angiokeratomas are rare verrucous vascular lesions that appear as dark red papules and plaques arranged either discretely or in clusters. As Imperial and Helwig wrote, these lesions are not true angiomas but are merely telangiectasias of preexisting vessels. The exact etiology is unknown, although congenital cause, pregnancy, chilblains, trauma, and tissue asphyxia are given as causal factors. There have been few reports of angiokeratoma circumscriptum following the excision of lipoma. We report a rare case of angiokeratoma circumscriptum following the excision of a lipoma, from the same area, on the right foot 3 years prior. Therefore, this case indicates that injury could be involved in the development of angiokeratoma circumscriptum.
Informed consent from the parents obtained for publishing the photographs of the child.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Schiller PI, Itin PH. Angiokeratomas: An update. Dermatology 1996;193:275-82.
Newton JA, McGibbon DH. The treatment of multiple angiokeratomata with the argon laser. Clin Exp Dermatol 1987;12:23-5.
Kwon NH, Kim SY, Kim GM. A case of post-injury angiokeratoma circumscriptum of the chest. Ann Dermatol 2010;22:66-8.
Kim JH, Kim MR, Lee SH, Lee SE, Lee SH. Dermoscopy: A useful tool for the diagnosis of angiokeratoma. Ann Dermatol 2012;24:468-71.
Campos-do-Carmo G, Ramos-e-Silva M. Dermoscopy: Basic concepts. Int J Dermatol 2008;47:712-9.
Zaballos P, Daufí C, Puig S, Argenziano G, Moreno-Ramírez D, Cabo H, et al
. Dermoscopy of solitary angiokeratomas: A morphological study. Arch Dermatol 2007;143:318-25.
Saha M, Barlow R, Bunker CB. Angiokeratoma circumscriptum of the penis. Br J Dermatol 2006;154:775-6.
[Figure 1], [Figure 2], [Figure 3]