Medical Care

Because acroangiodermatitis is rarely reported, most of the treatment reports are of anecdotal nature. Oral erythromycin treatment led to improvement in 2 cases of pseudo-Kaposi sarcoma in patients who had acquired arteriovenous fistula from hemodialysis. Compression therapy led to nearly complete resolution of the lesions in 5 months.^[15]Intermittent pneumatic compression therapy was also described.^[16]A 3-month course of dapsone (50 mg PO bid) combined with leg elevation and elastic support stockings led to complete regression of the lesions in one patient with acroangiodermatitis.^[17]

Surgical Care

Surgical elimination of the shunts is curative in acroangiodermatitis accompanying arteriovenous malformations. Multiple, small fistulae can be destroyed individually or by embolization; however, the latter method can lead to ischemia and necrosis.

Consultations

Consult a phlebologist for the management of the underlying vascular problems. Consult a physiotherapist for management of the underlying circulatory problem. If a limb prosthesis is present, evaluate its mechanical effect on the stump.

Diet

If the patient is obese, losing body weight may improve the circulation of the extremities.

Activity

Activity can be continued as allowed by the condition of the extremities and the underlying condition.

Long-Term Monitoring

Further outpatient care depends on the underlying disease.

Medication

Gucluer H, Gurbuz O, Kotiloglu E. Kaposi-like acroangiodermatitis in an amputee. Br J Dermatol. 1999 Aug. 141(2):380-1. [QxMD MEDLINE Link].
Sbano P, Miracco C, Risulo M, Fimiani M. Acroangiodermatitis (pseudo-Kaposi sarcoma) associated with verrucous hyperplasia induced by suction-socket lower limb prosthesis. J Cutan Pathol. 2005 Jul. 32(6):429-32. [QxMD MEDLINE Link].
Landthaler M, Langehenke H, Holzmann H, Braun-Falco O. [Mali's acroangiodermatitis (pseudo-Kaposi) in paralyzed legs]. Hautarzt. 1988 May. 39(5):304-7. [QxMD MEDLINE Link].
Kim TH, Kim KH, Kang JS, Kim JH, Hwang IY. Pseudo-Kaposi's sarcoma associated with acquired arteriovenous fistula. J Dermatol. 1997 Jan. 24(1):28-33. [QxMD MEDLINE Link].
Larralde M, Gonzalez V, Marietti R, Nussembaum D, Peirano M, Schroh R. Pseudo-Kaposi sarcoma with arteriovenous malformation. Pediatr Dermatol. 2001 Jul-Aug. 18(4):325-7. [QxMD MEDLINE Link].
Lyle WG, Given KS. Acroangiodermatitis (pseudo-Kaposi's sarcoma) associated with Klippel-Trenaunay syndrome. Ann Plast Surg. 1996 Dec. 37(6):654-6. [QxMD MEDLINE Link].
Zutt M, Emmert S, Moussa I, et al. Acroangiodermatitis Mali resulting from arteriovenous malformation: report of a case of Stewart-Bluefarb syndrome. Clin Exp Dermatol. 2008 Jan. 33(1):22-5. [QxMD MEDLINE Link].
Wei-Min Tan A, Lee JS, Pramono ZA, Chong WS. Acroangiodermatitis of Mali in protein C deficiency due to a novel PROC gene mutation. Am J Dermatopathol. 2012 Apr. 34(2):e19-21. [QxMD MEDLINE Link].
Horiguchi Y, Takahashi K, Tanizaki H, Miyachi Y. Case of bilateral acroangiodermatitis due to symmetrical arteriovenous fistulas of the soles. J Dermatol. 2015 Oct. 42 (10):989-91. [QxMD MEDLINE Link].
Huguen J, Bonsang B, Lemasson G, Misery L, Brenaut E. Image Gallery: Acroangiodermatitis or pseudo-Kaposi sarcoma: two cases in patients with paralyzed legs. Br J Dermatol. 2016 Jun. 174 (6):e84. [QxMD MEDLINE Link].
Kazakov DV, Sima R, Michal M. Hemosiderotic fibrohistiocytic lipomatous lesion: clinical correlation with venous stasis. Virchows Arch. 2005 Jul. 447(1):103-6. [QxMD MEDLINE Link].
Parsi K, O'Connor A, Bester L. Stewart-Bluefarb syndrome: Report of five cases and a review of literature. Phlebology. 2014 Aug 13. [QxMD MEDLINE Link].
Pimentel MI, Cuzzi T, de Azeredo-Coutinho RB, Vasconcellos Éde C, Benzi TS, de Carvalho LM. Acroangiodermatitis (pseudo-Kaposi sarcoma): a rarely-recognized condition. A case on the plantar aspect of the foot associated with chronic venous insufficiency. An Bras Dermatol. 2011 Jul-Aug. 86(4 Suppl 1):S13-6. [QxMD MEDLINE Link].
Kanitakis J, Narvaez D, Claudy A. Expression of the CD34 antigen distinguishes Kaposi's sarcoma from pseudo-Kaposi's sarcoma (acroangiodermatitis). Br J Dermatol. 1996 Jan. 134(1):44-6. [QxMD MEDLINE Link].
Pires A, Depairon M, Ricci C, Krayenbuhl B, Panizzon RG. Effect of compression therapy on a pseudo-Kaposi sarcoma. Dermatology. 1999. 198(4):439-41. [QxMD MEDLINE Link].
Orenay OM, Sarifakioglu E, Ozcan D, Köseoglu HK. An alternative treatment for acroangiodermatitis: intermittent pneumatic compression therapy. Acta Dermatovenerol Alp Panonica Adriat. 2013 Dec. 22(4):91-2. [QxMD MEDLINE Link].
Rashkovsky I, Gilead L, Schamroth J, Leibovici V. Acro-angiodermatitis: review of the literature and report of a case. Acta Derm Venereol. 1995 Nov. 75(6):475-8. [QxMD MEDLINE Link].

Media Gallery

The physical findings in this patient who is HIV negative remained the same over a 3-year period.
Lesions on the shin of a patient who is HIV negative.
Acroangiodermatitis on histopathologic examination.
Example of acroangiodermatitis on histopathologic examination.
Higher-power view of acroangiodermatitis on histopathologic examination.
Classic Kaposi sarcoma on the foot of an elderly patient who is HIV negative. Compare this photo to the clinical photos of acroangiodermatitis.
Classic Kaposi sarcoma on histopathologic examination.

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Author

Zoltan Trizna, MD, PhD Private Practice

Zoltan Trizna, MD, PhD is a member of the following medical societies: Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, American Society of Dermatopathology, Association of Professors of Dermatology, Society for Investigative Dermatology, Texas Dermatological Society

Disclosure: Book royalties from Elsevier publishers.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Shyam Verma, MBBS, DVD, FAAD Clinical Associate Professor, Department of Dermatology, University of Virginia School of Medicine; Adjunct Associate Professor, Department of Dermatology, State University of New York at Stonybrook School of Medicine; Adjunct Associate Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.