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Author: Dr Ian Coulson, Dermatologist, East Lancashire NHS Trust, Burnley, UK. Copy edited by Gus Mitchell. July 2021
Diffuse dermal angiomatosis of the breast is a rare but distinctive disorder of the skin usually affecting large pendulous female breasts and presenting with painful ulceration and reticulate erythema.
Diffuse dermal angiomatosis of the breast
Although diffuse dermal angiomatosis (DDA) affects both sexes, diffuse dermal angiomatosis of the breast (DDAB) has so far only been reported in women, particularly those with large pendulous breasts, who are obese, and are current active or past smokers. The age range has been 20 to 62 years (mean age 47). Diffuse dermal angiomatosis is usually diagnosed in association with peripheral vascular disease.
Diffuse dermal angiomatosis is considered to be a variant of reactive cutaneous angioendotheliosis with excess vascular proliferation resulting from chronic hypoxaemia of the skin. Breast skin hypoxia is thought to be due to the weight of breast tissue stretching the overlying skin and impeding skin blood flow. DDAB has been reported in women with smaller breasts who have internal mammary artery arteriosclerosis.
Diffuse dermal angiomatosis of the breast is usually bilateral and symmetrical, although it can begin on just one breast. It begins over the lower quadrants on the breasts and may spread to the skin of the upper quadrants.
Diffuse dermal angiomatosis of the breast has been reported in African American women as violaceus to erythematous reticular plaques with induration and ulceration. Telangiectatic vessels may be more difficult to appreciate in skin of colour.
Diffuse dermal angiomatosis of the breast in skin of colour
Image reproduced with permission from: Adams BJ, Goldberg S, Massey, Takabe K. A cause of an unbearably painful breast, diffuse dermal angiomatosis. Gland Surgery. 2012;1(2):132-5.
Diffuse dermal angiomatosis of the breast can be diagnosed on the history and clinical examination.
Investigations may include:
Histology of diffuse dermal angiomatosis of the skin
Image reproduced from: Galambos J, Simmen CM, Schmid R, Steinmann LS, Kempf W. Diffuse dermal angiomatosis of the breast: a distinct entity in the spectrum of cutaneous reactive angiomatoses – clinicopathologic study of two cases and comprehensive review. Case Rep Dermatol. 2017;9:194-205.
Diffuse dermal angiomatosis of the breast tends to follow a recurrent course of episodic painful ulceration. Surgery for peripheral vascular disease or large pendulous breasts can lead to permanent remission.
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