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Dermoscopy findings of umbilical endometriosis

a dermal hypersensitivity reaction associated with viral infections (Echovirus, Coxsackie B, Epstein–Barr, Cytomegalovirus), drugs (including chemotherapy), foods, herbal medicine (deer horn, gingko nut, Kalopanax pictus), allergens and malignancies (acute lymphoblastic leukaemia). Eruptive pseudoangiomatosis manifests as lesions consisting of small erythematous angioma-like papules with a perilesional pale halo, most commonly found in the extremities. A prodrome of fever, sore throat or gastrointestinal symptoms is usually present. It tends to resolve spontaneously in 1-2 weeks in children and 1-3 months in adults without sequelae; nevertheless, recurrences have been reported. Less common in adults, the first cases were reported in 8 women and 1 man with an acute rash of numerous erythematous and telangiectatic papules on the face, limbs and trunk. Unlike children, in adults, there is a predominance in women with no prodrome and a longer duration. Our case was atypical, being a male patient with an axial distribution affecting the scalp, face and trunk with a duration of approximately 2 years. Routine laboratory test are normal. Occasionally, there is leukopenia and lymphocytosis. Echovirus identification and positive serology for Epstein–Barr and Coxsackie virus along with prodrome, familial cases and a seasonal presentation during summer point to a viral aetiology. However, most patients do not have a confirmed infectious aetiology. Histopathology shows dilated dermal blood vessels with plump endothelial cells and a mild to moderate lymphohystiocitic perivascular infiltrate. There is no evidence of vascular proliferation in the dermis or vasculitis. Differential diagnosis includes viral exanthema, papular urticaria, multiple eruptive capillary hemangiomas, insect bites and leukocytoclastic vasculitis, among others. No specific treatment is needed; however, pruritus can be managed with oral antihistamines and topical steroids, but this does not change the course of the disease. A chronic and persistent evolution of 2 years and an axial distribution sparing the limbs make this an atypical case of eruptive pseudoangiomatosis.