Abstract:

Diffuse dermal angiomatosis (DDA) is a reactive cutaneous angiomatosis first described in 1994. Clinically, it is characterized by ill-defined non-healing violaceous plaques that may sometimes ulcerate. Histologically, diffuse proliferation of CD31-endothelial cells interspersed with collagen bundles in the reticular dermis is seen. Notably, endothelial atypia, mitosis, or any signs of vasculitis are absent. Vascular proliferation in DDA is hypothesized to result from ischemia secondary to arteriovenous fistula (AVF), atherosclerosis, or macromastia. The differential diagnosis of DDA includes acroangiodermatitis (pseudo-Kaposi sarcoma), Kaposi sarcoma, and low-grade angiosarcoma. Clinicopathologic findings and immunohistochemical stains can aid in making the diagnosis of DDA. Currently, there is no standard treatment of DDA. Isotretinoin and corticosteroids have been reported to be effective in selected cases. We report a case of a 30-year-old man with end-stage renal disease undergoing dialysis who presented with ulceration and granulation tissue formation around his arteriovenous fistula on the right ventral proximal forearm. Prompt recognition of DDA and differentiating this rare but benign condition is crucial. An overly aggressive approach can be avoided as DDA tends to resolve when the underlying ischemic process is addressed.

Financial Disclosure:
No current or relevant financial relationships exist.

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Mohammad Khan, DO

Biography