Dermatology Online Journal
- Author(s): Namazi, Mohammad Reza, MD
- Handjani, Farhad, MD
- et al.
From the Dermatology Department, Shiraz University of Medical Sciences, Iran. namazi_mr@ yahoo.com
Mohammad Reza Namazi MD and Farhad Handjani MD
Dermatology Online Journal 9(3): 19
Angioma serpiginosum is characterized by minute, coppery to bright-red, angiomatous puncta affecting mainly girls under age 16. The eruption predominates on the lower extremities. It is usually slowly progressive and chronic. The most important histological finding is the presence of dilated and tortuous capillaries in the dermal papillae and upper dermis. Although involution may occur, it is never complete. Treatment with a pulsed-dye laser improves or eliminates the disorder.
Case report.—A 21-year-old woman presented with minute, bright-red macules on an erythematous background, involving the right forearm (Fig. 1).
No purpura was present. The lesions were asymptomatic and she had no other complaints or medical problems. Her condition started as a small patch when she was 12 years old and slowly progressed afterward.
Angioma serpiginosum is characterized by minute, copper-colored to bright-red macules that have a tendency to become papular. They occur in groups, which enlarge through the formation of new lesions at the periphery, while those at the center fade. In this manner, small rings or serpiginous patterns are formed. No purpura is present, but a netlike or diffuse erythema forms the background.[1, 2] The eruption predominates on the lower extremities but may affect any region of the body except the palms, soles, and mucocutaneous junctions. Although it affects both sexes at all ages, 90 percent of cases occur in girls under age 16.
The condition starts as one or more small patches that usually enlarge over a period of months or years.  Although involution may occur, it is generally never complete. Long reported effective treatment with a pulsed dye laser that improved or eliminated lesions of angioma serpiginosum.
Angioma serpiginosum must be differentiated from the progressive pigmentary purpuric diseases. In Schamberg disease, the so-called cayenne pepper spots are macules that tend to coalesce and form diffusely pigmented patches. Purpura annularis telangiectodes (Majocchi) is bilateral and is characterized by acute outbreaks of telangiectatic macules that enlarge peripherally to form small rings. In lichenoid purpuric and pigmentary dermatosis of Gougerot and Blum, the primary lesion is a minute, lichenoid, red-brown papule that is sometimes hemorrhagic. Central involution and residual pigmentation is commonly observed.
Occasionally, the clinical appearance of angioma serpiginosum may resemble one of the progessive pigmenary purpuric diseases, and the diagnosis must be made histologically. Dilated and tortuous capillaries in the dermal papillae and the upper dermis are prominent in angioma serpiginosum, but are not seen in the progressive pigmented purpuras. Further, no inflammatory infiltrate or extravasation of red cells are observed in angioma serpiginosum, although these findings are typical in the progressive pigmented purpuras.  Additional feactures of angioma serpiginosum include dilated capillaries that show no alkaline phosphatase activity, in contrast to normal capillaries, and a dilated subpapillary venous plexus which produces the characteristic background erythema.
References1. Odom RB, James WD, Berger TG. Andrews' Diseases of the Skin. Philadelphia: W.B. Saunder's Company, 2000: 749-750
2. Barker IP, Suches PM. Angioma serpiginosum. Arch Dermatol 1965; 92: 613-620
3. Dowd PM and Champion RH. Disorders of blood vessels. In: Champion RH, Burton JL and Breathnach SM, eds. Textbook of Dermatology. Oxford: Blackwell Scientific Publications, 1998: 2092-2093
4. Long CC. Treatment of angioma serpiginosum using a pulsed tunable dye laser. Br J Dermatol 1997; 136: 631.
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