Atrophie Blanche: Periodic Painful Ulcers of Lower Extremities: A Clinical and Histopathological Entity

A clinicopathologic and histochemical study of ten patients with atrophie blanche indicate the disease is a distinct entity and not a variation of stasis dermatitis. Atrophie blanche is characterized by the development of periodic painful ulcers on the lower extremities. Telangiectatic pupuric areas appear and subsequently central ulcerations develop. The ulcers heal slowly and leave residual white atrophic scars. Striking histopathologic changes occur and consist of the presence of fibrinoid material in the superficial blood vessels and stroma, and infarction of the epidermis and superficial corium. Response to treatment is not satisfactory, but the lesions usually heal after several months. The etiology of atrophie blanche is not known but our abservations indicate a high incidence of atopic reactivity, eczematous eruptions, and systemic disease. The histopathologic changes suggest that atrophie blanche represents a localized hypersensitivity type vasculitis.