Violaceous Papules of the Back: A Quiz
Rym Benmously-Mlika, Houda Hammami and Incaf Mokhtar
Dermatology Department, Habib Thameur Hospital, N8 Ali Ben Ayed Street, 1008 Tunis, Tunisia. E-mail: rym.benmously@rns.tn
Violaceous Papules of the Back: A Quiz
Rym Benmously-Mlika, Houda Hammami and Incaf Mokhtar
Dermatology Department, Habib Thameur Hospital, N8 Ali Ben Ayed Street, 1008 Tunis, Tunisia. E-mail: rym.benmously@rns.tn
A 13-year-old boy presented to our dermatology department with a 3-month history of recurrent violaceous papules on his back. His previous medical history was otherwise unremarkable.
One papule had been excised by another physician 4 weeks earlier. Clinical examination revealed the presence of multiple small violaceous papules of 0.5 to 1.5 cm in diameter surrounding the excision site (Fig. 1).
Fig. 1. Multiple small violaceous papules of 0.5 to 1.5 cm in diameter surrounding the excision site.
Histological analysis of a biopsy specimen taken from one of the papules revealed lobules of angiomatous tissue within the papillary dermis (Fig. 2a), containing large numbers of vessels whose lumens were covered by normal-looking endothelial cells (Fig. 2b).
Fig. 2. (a) Lobules of angiomatous tissue within the papillary dermis (H&E, ×20). (b) Abundant vessels with lumens covered by normal-looking endothelial cells (H&E, ×40).
doi: 10.2340/00015555-1008
What is your diagnosis? See next page for answer.
Violaceous Papules of the Back: A Comment
Acta Derm Venereol 2011; 91: 491–494 (contd).
Diagnosis: Recurrent pyogenic granuloma or Warner and Wilson-Jones syndrome (1, 2)
A diagnosis of Kaposi’s sarcoma disease or melanoma can be excluded based on the observed histopathological features.
Recurrent pyogenic granuloma describes the appearance of multiple satellite papules around the site of a pyogenic granuloma between 1 and 4 weeks after its initial treatment. This phenomenon usually affects young patients. As in our patient, lesions are often located on the back and the scapular area.
The release of vascular endothelial growth factor after trauma is a relevant pathogenic mechanism (3). Recurrent pyogenic granuloma is a benign condition in which spontaneous involution occurs within 6 to 12 months.
Nevertheless, several possible treatments have been described (4, 5). These include surgical excision, curettage, electric cauterisation, carbon dioxide laser therapy, compression, cryotherapy, and the use of an intense pulsed light system. The recurrence rate has been estimated at between 16 and 50% (6, 7).
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