Quiz 25: What is your diagnosis?

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Diagnosis: Quiz 25

Quiz 25

Answer:  Generalized essential telangiectasia

Criteria for diagnosis clinically: Widespread, involving lower extremities especially, blotchy rust-colored lesions that on closer examination can be seen to consist of telangiectases innumerable are those of generalized essential telangiectasia.

Differential diagnosis clinically:  This condition could be misconstrued as poikiloderma because the zones of "sparing" could be misinterpreted as hypopigmentation in conjunction with telangiectases. The absence of hyperpigmentation and atrophy are additional features that militate against poikiloderma of any kind.

Criteria for diagnosis histopathologically: Striking telangiectases in the upper part of the reticular dermis, the venules not only being dilated widely but assuming shapes various, some of them bizarre, are attributes of generalized essential telangiectasia.

Differential diagnosis histopathologically: The telangiectases, conceivably, could be a consequence of another process pathologic, reference to aspects clinical being crucial to coming to a diagnosis with specificity.

Clinicopathologic correlation: The telangiectases observed histopathologically are responsible for the telangiectases seen clinically. The rust-color is a result of venules expanded mightily in the reticular dermis having been filled in vivo with erythrocytes.

Options for therapy predicated on knowledge of histopathologic findings: The process is too widespread to attempt to manage it by methods employed usually for obliterating dilated end vessels, such as injection into them of hypotonic saline or obliteration of them by a laser. In short, no treatment is effective for generalized essential telangiectasia.

1) The word ";essential" in the title of this condition means idiopathic. What is essential, too, is the genetic nature of this widespread vascular process and the character anatomic of it, namely, ectasia of end blood vessels, that being dilation inordinate of vessels already existing.

2) The pattern of inheritance of generalized essential telangiectasia is thought to be autosomal dominant and families so affected have been identified.

3) Generalized essential telangiectasia usually makes itself known in the fourth or fifth decades of life, and although it has predilection for the lower extremitie, the upper extremities and the trunk sometimes are affected as well.

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