Poikiloderma vascular atrophic: causes, symptoms, diagnosis, treatment

Poikiloderma vascular atrophic (syn.: poikiloderma Jacobi, atrophoderma erythematous reticularis Müller, etc.) is clinically manifested by a combination of atrophic changes in the skin, de- and hyperpigmentation, spotted or reticular hemorrhages and telangiectasias, which gives the skin a peculiar "motley" appearance. The most significant changes are observed on the face, neck, upper half of the trunk and limbs, but the process can be universal. The skin is dry, wrinkled, flaky, hair falls out. Sometimes there is mild itching. In poikiloderma of Civatte, the lateral surface of the neck and upper chest are affected. Poikiloderma caused by X-rays is limited to the site of irradiation.

Pathomorphology. Histological changes in the skin in various types of vascular poikiloderma are identical. In the early, erythematous stage, moderate atrophy with smoothing of epidermal outgrowths and hydropic dystrophy of the cells of the basal layer are revealed in the epidermis. In the upper part of the dermis, there is a fairly dense strip-like infiltrate of lymphocytes with an admixture of histiocytes and melanophages containing a large amount of pigment. The infiltrate cells sometimes penetrate the epidermis. The capillaries are dilated, the collagen fibers are edematous, homogenized in places. Sebaceous glands and hair are absent. In the late stage of the process, the epidermis is atrophic, the basal epithelial cells are vacuolated, inflammatory infiltrates are insignificant, they contain many melanophages. Similar changes are found in scleroderma, but in the latter, the dermis is thickened. In poikiloderma combined with mycosis fungoides, histological changes in the dermis correspond to the picture of mycosis fungoides. Unlike lupus erythematosus, which is accompanied by vacuolization of the cells of the basal layer, the infiltrate in vascular poikiloderma is strip-like and very superficial.

Histogenesis. There is a point of view on the independence of this form of skin atrophy (idiopathic form), but most authors consider it as a phase or outcome of a variety of pathological conditions: dermatomyositis, lupus erythematosus, scleroderma, lymphogranulomatosis, mycosis fungoides, parapsoriasis and other chronic dermatoses, including some genodermatoses. They can develop under the influence of physical factors - ionizing radiation, low and high temperatures, as well as chemical effects of petroleum distillation products, drugs, especially arsenic-containing ones. Hormonal dysfunctions, malabsorption, and the possible role of alloimmune reactions also contribute to the development of diseases.

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