it has been described in patients with increased venous pressure and stasis caused by venous insufficiency , congenital / acquired arteriovenous anomalies , arteriovenous shunts and lower limb paralysis or amputation stumps .
different names , like congenital dysplastic angiopathy , pseudo - kaposi sarcoma , and acral capillary angiomatosis , have been used .
first type namely the mali type of acroangiodermatitis is related to chronic venous insuffiency and second the stewart - bluefarb type is associated with arteriovenous malformations .
this lesion is usually encountered mostly on extensor surfaces of lower extremities , and clinically characterized by angiomatous red - violaceous , brown papules , plaques or nodules .
it is seen more frequently in males and according to underlying causes may be presented in childhood or early adulthood .
a 26-year - old male was admitted to our hospital with unilateral , multifocal irregularly contoured , purplish red colored , papular , plaque - shaped and nodular lesions on his right ankle .
microscopically epidermis showed minimal achantosis with a melanin pigment increase in the basal cell layer .
the lesion was located in dermis demonstrating a lobular architecture and was composed of small proliferating capillaries that are separating from each other with a slightly edematous matrix or forming nodular structures in which the luminal formations can hardly be identified .
stroma contained minimal spindle cell proliferation around vessels , diffuse hemosiderin granules and extravasated erythrocytes .
( h and e , 400 ) for differential diagnosis , immunohistochemical stains cd 34 , cd 31 and factor 8 were used .
positive immunostainings for cd 34 , cd 31 , and factor 8 were observed in endothelial cells figure 5 .
acroangiodermatitis is vasoproliferative disorder which is mostly related to vascular stasis and venous insufficiency , but rare cases without venous dysfunction are reported as in our case . whereas some authors classify acroangiodermatitis as a vascular lesion , it is a variant of stasis dermatitis and takes place in the group of eczematous diseases according to some authors .
compared with other eczematous diseases it is more pigmented , and prone to develop stasis ulcers .
histologically stasis dermatitis includes more dilated papillary dermal small blood vessels and more hemosiderin accumulation , shows more fibrosis or even sclerosing panniculitis in older lesions .
in addition to these features , exuberant vascular proliferation is characteristic feature of acroangiodermatitis , which most importantly makes it resembling kaposi sarcoma both histologically and clinically .
acroangiodermatitis has been commonly described in patients with increased venous pressure and stasis caused by mostly venous insufficiency , less commonly congenital / acquired arteriovenous anomalies , arteriovenous shunts and lower limb paralysis , particularly at lower distal extremities .
although exact etiology is not clear , increased venous pressure and stasis cause chronic hypoxia which induces neovascularization and fibroblast proliferation .
the role of angiogenetic factors , like pge1 and heparin , induced by several causes seems to be important in vascular proliferation .
there are thick - walled , dilated capillaries showing reduplication may be indicating angiomatous appearance .
some lesions may show nodular collections of vessels with narrow lumina . there may be mild perivascular fibroblastic proliferation .
in addition to that , extravasated erythrocytes , horizontally arranged spindle cells , fibrosis , numerous hemosiderin pigment accumulation may be present .
similar appearance , hypertrophic and tortuous venules can be observed in deep dermis but in kaposi sarcoma the vessels have more jagged outline and may show  promontory sign  which is characterized by protruding new formed small vessels into the larger vascular space . in acroangiodermatitis the angiomatous capillaries are separated by an edematous matrix .
an important feature is that in acroangiodermatitis there is proliferation of the preexisting vasculature rather than new vascular formation seen in kaposi sarcoma . in kaposi sarcoma there
is slit - like inconspicuous lumina , there are fascicles of spindle cells which are sometimes branching whereas in acroangiodermatitis vessels form nodular collections with narrow but more regular lumina
. there may be mild perivascular fibroblastic proliferation around vessels in both lesions but these cells do not stain with cd 34 in acroangiodermatitis whereas they are positive with cd 34 in kaposi sarcoma .
in kaposi sarcoma there is atypia in endothelial cells , small hyaline globules due to erytrophagocytosis and plasma cells can be observed in perivascular inflammatory infiltrate but in acroangiodermatitis there is no or minimal atypia in endothelial cells and other findings are not usual .
there are other diseases like pigmented purpuric diseases , vasculitis , stasis dermatitis , vascular forms of fibrous histiyocytoma , and other hemangiomata in differential diagnosis of acroangiodermatitis . in stasis dermatitis
there is more parakeratosis and spongiosis in epidermis , lesions are located deeper in dermis and there is more hemosiderin pigment deposition . in vasculitic lesions
kaposi sarcoma versus acroangiodermatitis treatment of acroangiodermatitis is important to prevent further complications such as bone demineralization , soft tissue destruction , congestive heart failure and infection .
treatment includes correction of any underlying congenital or acquired vascular disorder , conservative methods to reduce venous stasis , and local wound care .
with all these clinical , histopathological , and immunohistochemical findings we diagnosed this lesion as acroangiodermatitis . here
, it is discussed since no venous insufficiency or any reason for venous pressure increase and prominent stasis could be found .
in addition , this lesion closely resembles kaposi sarcoma and differential diagnosis is important as the treatment of kaposi sarcoma involves skin grafting and radiotherapy . 

acroangiodermatitis needs to be evaluated carefully and distinguished from kaposi sarcoma.acroangiodermatitis can be seen without venous insufficiency or prominent venous stasis as in our case . 
 
acroangiodermatitis can be seen without venous insufficiency or prominent venous stasis as in our case .
 acroangiodermatitis is a rare self - limited angioproliferative lesion which can be associated with congenital vascular malformations or acquired venous insufficiency . despite of its benign character , differential diagnosis of this lesion 
 is very important because it closely resembles kaposi sarcoma . here 
 we present a 26-year - old male patient with unilateral , purplish - red colored papules on his right ankle which diagnosed as acroangiodermatitis and discuss histopathological features , differential diagnosis and treatment of this unusual condition . 
Introduction
Case Report
Discussion