Erythematous-violaceous plaque in a young patient with chronic venous insufficiency

Abstract

A 44-year-old female patient with a history of chronic venous insufficiency in both lower limbs—treated with diosmin and hesperidin—was referred to the Dermatology Department due to a dermatosis on her right leg that had been present for one year. Physical examination revealed an erythematous-violaceous plaque measuring 2 x 6 cm, located on the medial aspect of the right leg (Photo 1). The lesion was indurated, slightly pruritic, and tender to palpation, with irregular borders, hyperpigmented areas, and a keratotic surface. Edema was also observed in both lower limbs. Peripheral pulses were intact. Dermatoscopy revealed a rainbow pattern surrounding a serosanguineous crust (Photo 2). The patient denied any prior trauma. Comprehensive laboratory testing, including serology, yielded no pathological findings. Arterial and venous Doppler ultrasound of both lower limbs showed bilateral insufficiency of the great saphenous vein along its entire course, more pronounced on the right side. A punch biopsy was performed for histopathological analysis; this revealed epidermal hyperkeratosis and acanthosis, along with numerous clustered capillaries in the dermis (Photo 3). These capillaries exhibited thickened walls associated with erythrocyte extravasation and hemosiderophages, surrounded by fibrosis, with no evidence of cytologic atypia. Perls' staining highlighted the presence of iron (Photo 4). Testing for human herpesvirus 8 (HHV-8) DNA was negative. Treatment consisted of general measures, clobetasol cream, compression therapy, venotonics, and moisturizers; a consultation with the Phlebology Service was also requested for joint follow-up. Unfortunately, the patient did not return for subsequent check-ups, and follow-up was lost.