Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Obervation Letter
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology
View/Download PDF
Net Letter
doi: 10.4103/0378-6323.182972
PMID: 27241499

Angioma serpiginosum: A case series of 4 patients

Premanshu Bhushan1 , Sarvesh Sunil Thatte1 , Avninder Singh2
1 Department of Dermatology, Venereology and Leprosy, Dr. P.N. Behl Skin Institute and School of Dermatology, New Delhi, India
2 Department of Pathology, Institute of Pathology, Indian Council of Medical Research, New Delhi, India

Correspondence Address:
Sarvesh Sunil Thatte
Department of Dermatology, Venereology and Leprosy, Dr. P.N. Behl Skin Institute and School of Dermatology, New Delhi - 110 048
How to cite this article:
Bhushan P, Thatte SS, Singh A. Angioma serpiginosum: A case series of 4 patients. Indian J Dermatol Venereol Leprol 2016;82:588
Copyright: (C)2016 Indian Journal of Dermatology, Venereology, and Leprology


Angioma serpiginosum is clinically characterized by multiple copper to red-colored grouped macules that are arranged in serpiginous or gyrate patterns. Histologically, it is characterized by dilatation and proliferation of vessels in the papillary dermis.[1] The occurrence of angioma serpiginosum on the upper limb is rare while we were unable to find previous reports of its occurrence on the face and neck.

Four patients aged 20, 19, 22 and 27 years presented with complaints of multiple, well-defined, discrete to confluent, punctate, red to coppery macules and some papules on the right leg [Figure - 1], the right side of the upper lip, dorsum of nose and right cheek [Figure - 2], the right arm [Figure - 3], the left side of neck, left ear lobe and left preauricular region [Figure - 4], arranged in a nevoid pattern [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4] and [Table - 1]. On diascopy, the lesions in the first and fourth patient were non-blanchable while those in the second and third patient were partially blanchable. Ophthalmic and otorhinolaryngeal examination in patients having lesions on the face and neck did not reveal any abnormality.

Figure 1: Multiple, well defined, discrete to confluent, bright red coloured, macules having irregular margins present on the right lower limb
Figure 2: Multiple, well-defined, discrete to confluent, punctate, red-colored to coppery, partially blanchable macules and some papules present on the right side of face
Figure 3: Multiple, well-defined, erythematous to copper colored, partially blanchable, macules and papules having smooth surface and irregular margins present on the right arm
Figure 4: Multiple, well-defined, punctate, smooth surfaced, reddish brown colored macules with irregular margins present on the left side of neck, left ear lobe and left preauricular area
Table 1: Details of four cases of angiomaserpiginosum being reported

In all patients, the rest of the mucocutaneous examination, systemic examination and laboratory parameters were normal. Differential diagnoses of pigmented purpuric dermatosis, unilateral nevoid telangiectasia and angioma serpiginosum were considered in case 1 while unilateral nevoid telangiectasia and angioma serpiginosum were considered as differential diagnoses for cases 2, 3 and 4. Histopathological examination from an erythematous, non-blanchable macule revealed multiple proliferaing and dilated thin-walled capillaries with intraluminal presence of erythrocytes in the superficial papillary dermis without any evidence of extravasation of erythrocytes or hemosiderin deposition or perivascular inflammatory infiltrate [Figure - 5]. Periodic acid–Schiff staining revealed periodic acid–Schiff positive deposits around dilated blood vessels [Figure - 6] in all the four patients. On the basis of clinical examination and histological findings, a final diagnosis of angioma serpiginosum was made in all the four cases.

Figure 5: Multiple proliferated and dilated thin walled capillaries with intraluminal presence of erythrocytes in superficial papillary dermis (arrow) without any evidence of extravasation of erythrocytes or hemosiderin deposition (H and E, ×100)
Figure 6: Periodic acid–Schiff positive deposits around dilated blood vessels (arrow) (H and E, ×400)

Angioma serpiginosum, a rare, benign, acquired, vascular nevoid condition was first described by Hutchinson in 1889.[2] The condition is usually sporadic, has a female preponderance and mainly affects lower extremities and buttocks. The condition is an asymptomatic, yet progressive anomaly that usually starts in early childhood and stabilizes in adults. It is rare for angioma serpiginosum to undergo complete spontaneous involution; however it may undergo partial involution. Clinically, lesions are copper to bright red, punctate, non-blanchable or partially blanchable, grouped macules that may develop into papules with a background of erythema. Lesions enlarge by developing new lesions at the periphery with clearing of lesions in the center and this leads to a serpiginous or gyrate or ring-like morphology.[1]

Angioma serpiginosum is a mosaic condition of unknown etiology. Estrogen was considered to be an important hormone in the development of angioma serpiginosum owing to its proliferative effects on vascular endothelial cells supporting the role of hormones for the cause of increased incidence of angioma serpiginosum in women.[3] However, recently, the role of hormones in its pathogenesis was disproved due to the absence of estrogen and progesterone receptors on the involved blood vessels.[4] Another proposed etiology is an abnormal vascular response to cold that manifests as formation and aggregation of newly formed capillaries that leads to large ectatic vessels in the papillary dermis.[2]

Though angioma serpiginosum is more common in women, it may also occur in men, as in our case series.[5] Angioma serpiginosum predominantly affects the lower extremities and buttocks though the upper extremity as in our case, the sole, and other body sites can rarely be involved.[2],[4],[5] However, we were unable to find any previous reports of the involvement of the face and neck. Dermoscopy with the characteristic presence of round to oval red lagoons and histopathology showing proliferating and dilated capillaries in the superficial papillary dermis, periodic acid–Schiff positive deposits around involved vessels and absence of erythrocyte extravasation or hemosiderin deposits or inflammatory cells helps to differentiate angioma serpiginosum from its closest mimics, pigmented purpuric dermatoses and unilateral nevoid telangiectesia.[5] All four patients had periodic acid–Schiff positive deposits around dilated blood vessels. However, this finding needs further corroboration in larger studies before being considered a diagnostic marker of the condition.[5] Argon laser, pulsed dye laser and intense pulsed light may give promising results in terms of clearance of lesions.[1],[2],[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form. The patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Namazi MR, Handjani F. Angioma serpiginosum. Dermatol Online J2003;9:19.
[Google Scholar]
Chen JH, Wang KH, Hu CH, Chiu JS. Atypical angioma serpiginosum. Yonsei Med J2008;49:509-13.
[Google Scholar]
Xiao X, Hong L, Sheng M. Promoting effect of estrogen on the proliferation of hemangioma vascular endothelial cells in vitro. J Pediatr Surg1999;34:1603-5.
[Google Scholar]
Bayramgurler D, Filinte D, Kiran R. Angioma serpiginosum with sole involvement. Eur J Dermatol2008;18:708-9.
[Google Scholar]
Ilknur T, Fetil E, Akarsu S, Altiner DD, Ulukus C, Günes AT. Angioma serpiginosum: Dermoscopy for diagnosis, pulsed dye laser for treatment. J Dermatol 2006;33:252-5.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections