Atrophie blanche. Clinical diagnosis and treatment

In this report, we describe 11 Greek patients with atrophie blanche (AB). All patients had characteristic skin lesions: petechial or purpuric papules or hemorrhagic bullae, that became necrotic and formed ulcers which in turn, became atrophic scars with hyperpigmentation of the surrounding skin. The majority of patients presented these skin lesions on the lower limbs. Two had idiopathic AB, 3 in association with venous insufficiency of the lower extremities and 6 with livedo reticularis (LR) and/or Raynaud's phenomenon (RP). Prior to our evaluation, most of these patients were diagnosed as having skin vasculitis and were treated with prednisone and/or cyclophosphamide. We conclude that AB is a distinct clinical entity with characteristic skin lesions affecting the legs. The disease is associated mainly with LR and RP. Very careful clinical assessment is needed to avoid incorrect diagnosis and unnecessary and potentially harmful therapeutic intervention.