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.