ABSTRACT
A 13-year-old female patient presented with itchy rashes on the right foot for 5 years. Skin examination revealed scattered flat, reddish-purple, slightly scaling papules on the inner side of the arch of the right foot, scattered light red papules on the outer side of the right great toe, and scattered domed reddish-purple papules on the right heel with collar-shaped keratinization around the base. Histopathological examination of the papule on the right heel revealed epidermal hyperkeratosis, marked hyperkeratosis around the papule, thickened granular layer and focal liquefaction degeneration of the basal layer with no obvious hyperplasia of the spinous layer; a large number of lymphocytes and plasma cells without atypia infiltrated the dermis, in which there were many small- and medium-sized dilated thick-walled blood vessels lined with prominent plump endothelial cells. The patient was diagnosed with acral pseudolymphomatous angiokeratoma of children, and treated with long-pulsed 1 064-nm Nd: YAG laser once every month. After 7 sessions of treatment, the rashes regressed and decreased in number.
ABSTRACT
Acral pseudolymphomatous angiokeratoma of children (APACHE) is a recently recognized, rare clinical entity with only 20 reported cases worldwide. It is characterized by unilateral eruptions of multiple angiomatous papules, mostly on acral areas and mainly in children, although some cases have also been reported with involvement of non-acral areas and occurring in adults. The histopathologic examination revealed diffuse dermal infiltrates of lymphohistiocytes and thick-walled vessels lined with prominent plump endothelial cells. APACHE is a cutaneous pseudolymphoma, rather than a vascular neoplasm, because of distinct histopathologic and immunohistochemical findings. We report a case of a 9-year-old girl who presented with multiple angiomatous papules on her right upper arm. The histopathologic and immunohistochemical findings in our patient were consistent with a diagnosis of APACHE.