Diffuse Dermal Angiomatosis

A 53‐year‐old Caucasian male with peripheral vascular atherosclerosis presented with a 6‐week history of violaceous, tender, plaques with focal ulcerations of the mid left lower extremity. A biopsy specimen of the left leg plaque demonstrated a diffuse proliferation of benign endothelial cells in the papillary and reticular dermis with some forming small vascular spaces, occasional extravasating erythrocytes and no evidence of cholesterol emboli or vasculitis. There were no atypical endothelial mitoses or cytologic atypia. Immunohistochemical staining using endothelium‐specific anti‐CD31 antibody was positive. The clinical and pathological findings were consistent with diffuse dermal angiomatosis. The patient had a diagnostic angiogram that revealed a 1.5‐cm, focal, 80% stenosis of the midsegment of the left external iliac artery. He underwent left external iliac artery stenting with an Omnilink 8 mm by 28 mm balloon expandable stent. Poststent films showed resolution of the stenosis. Within 10 weeks of the revascularization procedure, he had complete resolution of his cutaneous manifestations. Diffuse dermal angiomatosis is a rare manifestation of a common co‐morbid condition in our ageing population. Early intervention to correct the ischemia of peripheral vascular disease results in rapid resolution of this unique clinico‐pathologic entity.