White ankle scars
We discovered that these white lesions were remnants of a deeper issue that linked back to significant events in the patient’s medical past.
Diagnosis: Atrophie blanche
Atrophie blanche is a morphologic feature described as porcelain-white stellate scars with surrounding telangiectasia and hyperpigmentation. The lesions are typically found over the peri-malleolar region and are sequelae of healed erythematous and painful ulcers. The lesions arise from upper dermal, small vessel, thrombotic vasculopathy leading to ischemic rest pain; if left untreated, atrophic white scars eventually develop.
A sign of venous insufficiency or thrombotic vasculopathy
Atrophie blanche may develop following healing of an ulcer due to venous insufficiency or small vessel thrombotic vasculopathy.1 The incidence of thrombotic vasculopathy is 1:100,000 with a female predominance, and up to 50% of cases are associated with procoagulant conditions.2 Thrombotic vasculopathy can be due to an inherited or acquired thrombophilia.1
Causes of hereditary thrombophilia include Factor V Leiden/prothrombin mutations, anti-thrombin III/protein C/protein S deficiencies, dysfibrinogenemia, and hyperhomocysteinemia.
Acquired thrombophilia arises from underlying prothrombotic states associated with the Virchow triad: hypercoagulability, blood flow stasis, and endothelial injury. The use of oral contraceptives or hormone replacement therapy, presence of malignancy, and antiphospholipid syndrome (APS) are causes of acquired thrombophilia.2
Obtaining a careful history is crucial
Thorough history-taking and physical examination are required to determine the underlying cause of atrophie blanche.
Continue to: Chronic venous insufficiency
