P026 A case of poikilodermatous plaque-like haemangioma initially masked by senile dermatitis

Abstract

Poikilodermatous plaque-like haemangioma (PPH) is a rare benign vascular proliferation. It typically presents as a solitary erythematous or violaceous atrophic plaque on the lower extremities of men aged 58–90 years and follows an indolent, treatment-resistant course. Its poikilodermatous appearance and associated dermal lymphocytic infiltrate can mimic cutaneous T-cell lymphoma (CTCL), posing a diagnostic challenge. We present an older man presenting with a 6-month history of widespread pruritic erythematous dermatitis, attributed to senile dermatitis. The generalized eruption responded well to topical corticosteroids; however, there remained a persistent, tender, scaly, erythematous atrophic plaque measuring 10 × 11 cm on the left posterior thigh. Skin scrapings were positive for fungal hyphae, yet topical antifungal therapy was ineffective, prompting further evaluation. A diagnostic skin biopsy revealed an atrophic epidermis with largely preserved keratinization and mild follicular plugging. The papillary dermis showed a patchy superficial inflammatory infiltrate composed predominantly of small, regular lymphocytes with occasional eosinophils and minimal epidermotropism. Prominent superficial dermal capillary proliferation was noted. There was no evidence of panniculitis, lymphocyte atypia or significant epidermotropism. Periodic acid–Schiff staining was negative for fungal elements. Overall, the findings were consistent with a poikilodermatous process, with no histological evidence to support a diagnosis of CTCL. This case highlights the importance of clinicopathological correlation in persistent or atypical presentations in older patients, particularly when CTCL is a consideration. Recognition of PPH is essential to differentiate it from more serious conditions, avoid unnecessary investigations and treatments, and reduce patient and clinician anxiety.