Atrophie Blanche

Atrophie blanche (AB) is a morphologic pattern of scarring that occurs secondary to a clinicopathologic entity known as livedoid vasculopathy. It is a chronic condition that presents as recurrent, painful, ulcers of the lower leg, ankle, or dorsal foot, predominately occurring in young to middle-aged females with subsequent scar formation. Atrophie blanche describes the result of healed ulcers. These characteristically present as a white, atrophic stellate scar with peripheral telangiectasias. Atrophie blanche is also known as livedoid vasculopathy, which in its purest form, is the primary, ulcerated lesion. Livedoid vasculopathy is poorly understood. It is believed to involve occlusion of the blood vessels in the superficial dermis with subsequent skin ulceration. There are several other less commonly used terms to describe this condition, such as segmental hyalinizing vasculitis, livedo reticularis with summer ulceration, and painful purpuric ulcers with reticular patterning on the lower extremities (PURPLE). Physical exam findings will depend on the disease stage but classically present in a middle-aged woman with bilateral, painful, purpuric lower leg lesions that develop punched-out ulcerations. These ulcers are chronic, slow to heal, and leave the classic stellate, white scars. Although it occurs more frequently in middle age females, it does occur in males, and there are a few case reports of disease in children. Many other diseases may present with a similar end-stage as atrophie blanche. The causes of atrophie blanche-like lesions include cutaneous small-vessel vasculitis and antiphospholipid antibody syndrome. These other disorders can be distinguished from atrophie blanche as the history will lack preceding punched-out ulceration.