Atrophie blanche L95.01

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

atrophy alba; Atrophy white; capillaritis alba; white atrophy

History
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Milian, 1929

Definition
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Usually highly painful, chronic vasculopathy of small skin vessels in (frequently localized) chronic venous insufficiency.

Etiopathogenesis
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Localized chronic venous insufficiency with consecutive chronic vasculopathy with vascular occlusion.

Localization
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Mainly perimalleolar area.

Clinical features
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Three-phase course:
  • Inflammatory phase: circumscribed livid-red foci.
  • Atrophic phase (white atrophy): Small, roundish, slightly sunken, scarred areas with surrounding brown pigmentation. Mostly capillary ectasia detectable at the margins.
  • Ulcerous phase ( atrophy blanch-ulcer): Possible formation of mostly small, less frequently superficial (erosions) or ulcers covering the entire atrophic zone. The clinical feature of these ulcers is a stabbing, persistent pain that is incompatible with the size of the ulcer.

Histology
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Arteriolitis, capillaritis, fibrin precipitation, microthrombi, sclerosis, atrophy of the epidermis.

Differential diagnosis
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General therapy
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Treatment of the underlying disease, see chronic venous insufficiency. Particularly important: Elimination of pain symptoms, e.g. by using non-steroidal anti-inflammatory drugs. Combination of wound treatment, local therapy, e.g. soft zinc paste R191, compression and immunosuppression.

External therapy
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In the inflammatory phase short-term glucocorticoids, e.g. betamethasone ointment(e.g. Betagalen, Betnesol) or 0.1% mometasone (e.g. Ecural fat cream), 0.25% prednicarbate (e.g. Dermatop ointment).

Internal therapy
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  • Acetylsalicylic acid (e.g. ASS) 2-3 g/day. In recurrent cases or marked resistance to therapy glucocorticoids in medium dosages, e.g. prednisolone 40-60 mg/day p.o. with gradual dose reduction (stomach protection!).
  • In rare cases of absolute resistance to therapy, the intravenous use of immunoglobulins ( IVIG) is recommended, e.g. with 0.2-1 g/kg bw (Intratect).

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020