Case presentation
An 11-year-old girl presented with multiple asymptomatic erythematous
lesions on the left abdomen which was first noticed by her mother as
multiple red pinhead-sized lesions during birth. The lesions
progressively extended with new satellite lesions appearing around the
previous lesions with the increase in age of the child. There was no
family history of similar skin lesions. There were no visual or
neurological symptoms.
Cutaneous examination revealed multiple discrete and confluent punctate
erythematous to violaceous macules on the left abdomen in T8 to T10
dermatomal distribution with normal surrounding and intervening skin
(Figure 1). There was no similar lesion in other parts of the body. Her
general physical and systemic examination was unremarkable.
Skin biopsy taken from the lesion showed epidermis with basket weave
hyperkeratosis, papillomatosis, and hypogranulosis. Papillary dermis
showed few ectatic congested thin-walled blood vessels. Few areas showed
downward growth of the rete ridges between these blood vessels.
Epidermal changes in the form of acanthosis and extravasation of RBCs,
inflammatory cell infiltration, and hemosiderin deposition were not seen
in the dermis (Figure 2a, 2b). Based on the clinical and
histopathological findings (HPE), a diagnosis of angioma serpiginosum
was made.
The patient and her parents were counseled about the benign nature of
the disease and planned for laser therapy if any cosmetic concerns in
the future.