DISCUSSION
Angioma serpiginosum (AS) is a rare vascular disorder described first by Hutchinson in 1889 as a “serpiginous or infective nevus” and then named by Crocker in 1894.2,3 Cases are usually sporadic, however familial cases with an autosomal dominant or X linked dominant inheritance and few cases with PORCN gene mutation or deletion have been reported .4 Angioma serpiginosum results from the proliferation of endothelial cells resulting dilated capillaries. There are various theories regarding its pathogenesis. One of the theories suggesting the role of estrogen while another theory calming the role of cold temperature in its pathogenesis. However, both of the theories are not accepted universally.7,8
The condition usually starts in childhood or birth with a female predominance.5,6 This condition presents as asymptomatic multiple, pinpoint violaceous or erythematous macules, non-blanching and clustered in an area or form a large sheets distributed in serpiginous, linear (Blaschkoid distribution) or annular pattern.1 Lesions are typically unilateral and located predominantly on the lower limbs and extremities but can be extensive.5,9 However, palms, soles, mucosal, and truncal involvement is rare. Few cases with segmental truncal and mono-lateral plantar area involvement have been reported.6,10,11,,12,13,14 This condition progresses slowly and usually attains stability at puberty with some partial spontaneous resolution in late adulthood. The diagnosis is usually made clinically that is confirmed by histological findings of distended ectatic capillaries lined by flattened endothelium cells of normal appearance and the absence of inflammation, erythrocyte extravasations, and hemosiderin deposition.15 Treatment is only indicated for cosmetic reasons for which vascular laser is the best option.
In our case, the patient presented with localized telangiectasia without skin atrophy. The differentials for the condition include Angioma serpiginosum, capillary malformation, unilateral nevoid telangiectasia, and purpuric conditions. 17 Presence of the lesions since birth as unilateral, asymptomatic erythematous, pinpoint to pinhead-sized non blanchable macules and papules in the zosteriform pattern (T8-T10) without atrophy and perilesional halo supports the diagnosis of angioma serpiginosum. The histological findings confirmed the diagnosis. The peculiarity about our case is the site of lesion. This is the first case as per our knowledge with presentation of the lesion on abdomen. In our case, the parents were not concerned about the lesions so, no treatment was given and asked for follow-up later in case of cosmetic concerns.