Late-onset tufted angioma with remarkable response to pulse dye laser.

Sir,

Tufted angioma (TA) is a rare benign vascular tumor. It is characterized by homogeneous pink to purple plaques associated by papules that spread slowly.[1]

A 52-year-old woman with a 1 year history of a purple patch with some dusky macules presented on the left side of her trunk was referred to our clinic. He had no history of local trauma. Patient suffered from occasional spontaneous sting and pain on pressure. She had no history of bleeding or ulceration of the patch and had no relevant medical or dermatological history. The condition started as a small raised macule with surrounding erythema and pain on pressure growing slowly until the lesion reached to 10 cm × 7 cm of size.

The physical examination showed a well-demarcated painless purple patch with the dusky macules located on the left side of the trunk [Figure 1]. The involved skin was warmer on palpation. There was no history of sweating or excessive growth of lanugo hair over the patch. Patient's cell blood count, platelet count and coagulation findings were normal. The skin biopsy showed discrete capillary ovoid lobules distributed in the reticular dermis and superficial subcutis with the “cannon ball” pattern. They were shown in the form of glomeruloid lobules consisting of spindle-shape endothelial cells closely packed together and separated by clefts containing red blood cells without atypia or mitosis. Ectatic lymphatic vessels are between lobules and in the adjacent tissue. Dermal collagen and subcutis separating capillary lobules are fibrotic [Figure 2]. According to the presentation, the diagnosis of acquired tufted angoima was made. We treated the lesion with pulse dye laser (PDL) 595 nm of wavelength, the fluence of 10 J/cm2 and pulse duration of 3 ms and spot size of 7 mm. This treatment performed once each months and interestingly marked improvement was seen after three sessions of treatment [Figure 3].

Figure 1

Well-demarcated painless purple patch with dusky macules on the left side of the trunk

Figure 2

Discrete capillary ovoid lobules distributed in the reticular dermis and superficial subcutis with the “cannon ball” pattern and glomeruloid lobules and no atypia or mitosis. (H and E, ×40)

Figure 3

Marked improvement after three sessions of pulse dye laser

TA is a rare tumor that scattered at various levels in the dermis and superficial subcutis.[23] 25% of the cases are congenital and half of them appear in the 1st year of life.[2] involving both sexes equally.[4] Delayed onset of TA has been reported in the fifth and sixth decades.[14] It usually Sweating over the plaque and growth of fine lanugo hair has been observed.[4]

Treatment of TA is usually unsatisfactory and recommended for cosmetic reasons or complications.[2] The treatment options included surgical excision, topical and systemic corticosteroids, vincristine and interferon, various lasers such as PDL and intense pulsed light.[23]

Hereby, we present an interesting patient with late onset of TA in a middle-age woman with remarkable response to PDL. However, response to PDL is variable. A successful treatment results in cosmetic improvement and alleviation of pain after treatment with the PDL similar to what we have reported in our case.[5] Finally, it could be recommended to consider TA in the differential diagnosis of any late onset bizarre tender erythematous patch.