Atrophie blanche - Altmeyers Encyclopedia - Department Vascular medicine

Synonym(s)

atrophy alba; Atrophy white; capillaritis alba; white atrophy

Milian, 1929

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

Vascular medicine

Benign, microcystic, cutaneous or cutaneous/subcutaneously localized, circumscribed lymphatic vasectasia (s...

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

Mainly perimalleolar area.

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.

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

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.

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).

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).