Atrophie blanche

Author: Vanessa Ngan, Staff Writer, 2004. Updated by Dr Ebtisam Elghblawi, Dermatologist, Tripoli, Libya, and DermNet NZ Editor in Chief, A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, November 2017. 


Atrophie blanche
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Synonyms:
White atrophy
Categories:
Vascular skin dIsorders
ICD-10-CM:
L95
ICD-11 MMS:
EF5Y
SNOMED CT:
238762002

What is atrophie blanche?

Atrophie blanche (white atrophy) is the name given to a particular type of angular scar arising on the lower leg or foot. It occurs after a skin injury, when the blood supply is poor and healing is delayed.

Atrophie blanche

What causes atrophie blanche?  

Atrophie blanche most often occurs in middle-aged women. It is most often associated with venous insufficiency. It is the hallmark of livedoid vasculopathy, and may also follow ulceration due to:

Atrophie blanche is due to occlusion of small blood vessels in the middle and deep dermis, which prevents normal healing. Blood vessel occlusion may be due to:

  • Microthrombi
  • Defective endothelium
  • Enhanced production of fibrin
  • Fibrin cuff formation
  • Increased platelet aggregation
  • White-cell trapping
  • Autoantibodies
  • Primary vasculitis
  • Infection.

What are the clinical features of atrophie blanche?

Atrophie blanche is characterised by:

  • Star-shaped or polyangular, ivory-white depressed atrophic plaques
  • Prominent red dots within the scar due to enlarged capillary blood vessels
  • Surrounding hyperpigmentation due to haemosiderin deposition.

What is the treatment of atrophie blanche?

Treatment is directed to the underlying disease process that leads to atrophie blanche.  For example, in livedoid vasculopathy, drugs are used that halt platelet aggregation and stimulate fibrinolysis.

Compression therapy may speed up healing of wounds on the lower leg, particularly in venous disease,  and thus reduce the severity of atrophie blanche scar formation.

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Related information

 

References

  • Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications.
  • Milstone LM, Braverman IM, Lucky P, Fleckman P. Classification and therapy of atrophie blanche. Arch Dermatol 1983 Dec;119(12):963-9. PubMed.
  • Sreedharan, S and Sinha, S. Atrophie Blanche [online]. Wound Practice & Research: Journal of the Australian Wound Management Association, Vol. 19, No. 2, Jun 2011: 74-80. Journal

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