Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
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 Issue
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 in Response to Previous Publication
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
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
Reviewers 2022
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
Study Letters
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
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Observation Letters
87 (
); 709-712

Is dermoscopy a useful tool in pseudo-Kaposi sarcoma?

Department of Dermatology, University Hospital Marques de Valdecilla, Santander, Spain
Department of Pathology, University Hospital Marques de Valdecilla, Santander, Spain
Corresponding author: Dr. Inigo Navarro-Fernandez, Avenida Valdecilla, 25, 39008, Santander, Spain.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Navarro-Fernandez I, Duran-Vian C, Gonzalez-Vela MC, Yange-Zambrano G, Gonzalez-Lopez MA. Is dermoscopy a useful tool in pseudo-Kaposi sarcoma? Indian J Dermatol Venereol Leprol 2021;87:709-2.


Pseudo-Kaposi sarcoma, also known as acroangiodermatitis, is a disorder characterized by the presence of a reactive proliferation of blood vessels that usually takes place on the patients’ limbs in the setting of different vascular disruptions. These include chronic venous insufficiency in acroangiodermatitis of Mali and congenital arteriovenous malformations in Stewart-Bluefarb syndrome.1,2

Clinically, patients present with violaceous papules that can coalesce into plaques, mimicking Kaposi sarcoma [Figure 1a]. On histological examination, pseudo-Kaposi is characterized by lobular vascular proliferation with associated perivascular fibrosis. Erythrocyte extravasation and dermal siderophages are frequently encountered [Figure 1b].

Figure 1a:: Clinical photograph of one of the patients’ lower leg showing the classical features of acroangiodermatitis
Figure 1b:: Histopathological image of one of the patients showing an exuberant proliferation of vessels with a lobular configuration. Red blood cell extravasation and hemosiderin deposition can be observed (H and E, ×200)

In this report, we describe the dermoscopic features of four cases of pseudo-Kaposi. We found only three previous dermoscopic descriptions in the literature. All patients were treatment naïve when they were first seen in our clinic, except for patient two, who had been using a furoate mometasone ointment for the past month with partial relief of his symptoms. In every case, the diagnosis was suspected clinically and confirmed with histopathological and immunohistochemical examination: CD34 was expressed in endothelial cells but not in the surrounding perivascular cells, whereas immunostaining was negative for human herpesvirus 8 (HHV-8) in all cases.

Clinical signs of chronic venous insufficiency were obvious in patients one, two and four, whereas patient three had suffered a previous deep venous thrombosis (diagnosed by Doppler ultrasound) three weeks before the lesions started to develop.

In preceding reports, irregular vessels and white structureless areas were described in two cases,2 while white rail lines, red and blue lacunae and hemorrhagic crusts were found on the other one.3 We believe that, overall, different terms were used to refer to similar structures.

The clinical and dermoscopic features of our patients are outlined in Table 1. In all cases, a clearly vascular pattern was appreciated. All of them presented a mauve to violaceous background color with polymorphic vessels which reflect the vascular proliferation (the red lacunae probably embodying the lobular proliferation) [Figure 2]. Polychromatic color change (or rainbow pattern), like the one described in Kaposi sarcoma, was demonstrated in three patients. While this was initially described as a specific sign for Kaposi sarcoma, it has now also been described in many other lesions, such as angiokeratomas, hypertrophic scars, melanoma and dermatofibroma.4 The exact mechanism by which this phenomenon occurs is still not well established. However, it is probably related to the different refraction indices of polarized light which exist throughout a disorganized dermis with increased vascularity.4

Table 1:: Clinical and dermoscopic features of the four patients
Patient Sex Age Duration of the disease Likely cause Clinical examination Dermoscopic features
1 Female 92 2 years CVI Bilateral violaceous plaques with superficial crusting, on the lower legs. Bluish background, polymorphic vessels, rainbow pattern, hemorrhagic crusts, WSS, sticky fiber sign
2 Male 77 6 months CVI Bilateral vascular looking plaques with satellite nodules and superficial scale, distally on the lower limbs. Polymorphic vessels, vascular lacunae, rainbow pattern, hemorrhagic crusts, WSS, peripheral coppery dots
3 Male 57 4 months DVT Unilateral shiny violaceous papules coalescing into a large plaque on the right leg Polymorphic vessels, vascular lacunae, rainbow pattern, WSS
4 Male 87 9 months CVI Bilateral shiny violaceous papules and plaques with intense scaling on the distal lower extremities Polymorphic vessels, vascular lacunae, WSS

CVI: Chronic venous insufficiency, DVT: Deep venous thrombosis, WSS: White shiny structure

Figure 2a:: Dermlite DL200 HR with polarized light (×10). Dermoscopic image of patient 1 revealing hemorrhagic crusts (yellow circle) and the “sticky fiber” sign (black circles)
Figure 2b:: Dermlite DL200 HR with polarized light (×10). Dermoscopic image of patient 2. Peripheral coppery dots (red circles) as well as white shiny structures (black arrows) are visible
Figure 2c:: Dermlite DL200 HR with polarized light (×10). Dermoscopic image of patient 3. White shiny structures (black arrows) and superficial scales (red arrows) can be observed
Figure 2d:: Dermlite DL200 HR with polarized light (×10). Dermoscopic image of patient 4. Irregular vessels (yellow arrows) and superficial scales (red arrows) are pointed out

White shiny structures, encompassing white shiny lines, white shiny areas and rosettes, were seen in all cases. They may correlate with fibroblastic proliferation and are probably linked to the interaction of polarized light with collagen due to a birefringence phenomenon.5 Superficial white scales were also present in all cases. They are likely to reflect the orthokeratotic hyperkeratosis which is sometimes demonstrated on biopsies.

The “sticky fiber” sign was present in the first case. This clue reflects the presence of spongiosis, transudation, excoriation or ulceration in different lesions and we believe it highlights the transudation which takes place as a result of the increase in blood pressure in the lower legs.6 In the second case, a peripheral, coppery pigmentation was also visible. This is likely to be secondary to the associated stasis dermatitis which causes extravasation of red blood cells and hemosiderin deposits. Thus, in these cases, dermoscopy was not only useful in establishing the diagnosis of this syndrome, but it also contributed to a better understanding of its etiology and its link to venous insufficiency.

The pathogenesis of acroangiodermatitis is still poorly understood. However, it has been suggested that it might potentially develop as a consequence of increased venous and capillary pressure leading to an angiogenic response. This response could be mediated by different angiogenic factors, including vascular endothelial growth factor and PGE1 which stimulate the proliferation of fibroblasts and endothelial cells.7 This blood pressure increase is also presumably responsible for the extravasation of hemosiderin that can be observed both dermoscopically and histologically.

Management of acroangiodermatitis should be focused on treating the underlying cause (including limb elevation and compressive bandages in cases secondary to chronic venous insufficiency and vascular surgery for arterovenous malformation).

When analyzing the morphological patterns of these cases (as well as the ones previously described in the literature), there seem to be certain structures which are present most of the time. These include vascular lacunae, polymorphic vessels, white shiny structures and even polychromatic color change.

We, therefore, believe that dermoscopy can be useful in distinguishing acroangiodermatitis from other conditions which can mimic it clinically. These include lichen planus (violet hue without irregular vessels), angiokeratomas (presence of dark lacunae without polymorphic vessels), pigmented purpuric dermatitis (absence of white shiny structures), lichen aureus (lack of white shiny structures, less prominent vascular pattern) and lichen simplex chronicus (faint vascularity with no lacunae). For differentiating from Kaposi sarcoma, there are some dermoscopic clues which could be explored. For instance, increased fibroblastic activity in pseudo-Kaposi sarcoma presenting as white shiny structures might be suggestive of this diagnosis. However, differentiation of both disorders based solely on clinical and dermoscopic grounds is virtually impossible in some cases. Consequently, we believe histopathology with immunostaining for HHV8, D2-40 and CD34 that remains the gold standard for the diagnosis of this disease.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


  1. , , , . Acroangiodermatitis of mali: A rare vascular phenomenon. Indian J Dermatol Venereol Leprol. 2010;76:553-6.
    [CrossRef] [Google Scholar]
  2. , , , . Dermoscopic features in two cases of acroangiodermatitis. Australas J Dermatol. 2018;59:e290-1.
    [CrossRef] [Google Scholar]
  3. , , , , , . Pseudo-Kaposi sarcoma: Report of a case investigated by dermoscopy, reflectance confocal microscopy and optical coherence tomography. J Eur Acad Dermatol Venereol. 2018;32:e429-32.
    [CrossRef] [Google Scholar]
  4. , . The rainbow pattern in dermoscopy: A zoom on nonkaposi sarcoma skin diseases. Biomed J. 2018;41:209-10.
    [CrossRef] [Google Scholar]
  5. , , , . Observation of chrysalis structures with polarized dermoscopy. Arch Dermatol. 2009;145:618.
    [CrossRef] [Google Scholar]
  6. , , , . Dermatoscopy Austria: Facultas.wuv; .
    [Google Scholar]
  7. , , , . Pseudo-Kaposi's sarcoma (Bluefarb-Stewart type) Int J Dermatol. 2005;44:136-8.
    [CrossRef] [Google Scholar]

Fulltext Views

PDF downloads
View/Download PDF
Download Citations
Show Sections