The following is a summation of a patient seen in clinic and subsequent literature review we conducted for publication in Baylor University Medical Center Proceedings.
Despite being benign, diffuse dermal angiomatosis (DDA) is a painful, irritating, and persistent inflammatory condition. Clinically, patient will present with tender, purple-to-red, ulcerated, itchy plaques. It often presents in middle-age and is associated with factors relating to tissue hypoxia (smoking, trauma, hypercoagulability, peripheral vascular disease, obesity, diabetes mellitus). There is no formal treatment, and there are no treatment guidelines in place. The most commonly reported location are the extremities, however it can also occur on the breasts (and appears to be most common in large breasted women).
For the breast related type, some success has been reported with revascularization or breast reduction procedures. Conservative treatments include isotretinoin, oral corticosteroids or pentoxifylline/aspirin. In some instances, spontaneous resolution also does occur. With this should come the recommendation to improve tissue oxygenation where possible (smoking cessation, control of diabetes, weight loss, blood pressure control, etc.).
DDA can be an indicator of severe atherosclerosis, and patients with relevant risk factors should undergo the appropriate work-up.
