A woman in her 40s presented with a 5-year history of spreading blanchable, purple, asymptomatic macules on her bilateral lower extremities. Her medical history was notable for an undifferentiated connective tissue disorder with associated joint pain, and she was receiving chloroquine phosphate and nonsteroidal anti-inflammatory drugs.
Physical examination revealed telangiectasias coalescing into purple-blue patches on bilateral dorsal feet and toes (Figure, A). The telangiectasias extended up to her knees bilaterally. She had palpable pulses bilaterally. The patient had normal arterial brachial indexes bilaterally and minimal reflux in the right common femoral vein on a venous duplex. The antinuclear antibody value was 1:320, but factor V Leiden, protein C, protein S, and partial thromboplastin time were normal. She also had negative cryoglobulins, cryofibrinogens, and cold agglutinins. A 4-mm punch biopsy was performed of a sample from her left forefoot (Figure, B and C).
Kaffenberger J, Helm K. Diffuse Telangiectasias on the Lower Extremities. JAMA Dermatol. 2014;150(4):451-452. doi:10.1001/jamadermatol.2013.7550