A white area like this on the lower leg surrounded by light
brown pigmentation and dot petechiae is called atrophie blanche. It is seen
particularly in overweight diabetic patients with stasis dermatitis. The white
area of skin is often firm due to underlying scarring and fat damage or
panniculitis. Biopsies here are slow to heal but may show a segmental
vasculitis. Treatment is difficult. The skin is already scarred and this will
not change. However further damage can be reduced by dealing with the stasis
through weight loss and support stockings and treatment of underlying varicose
veins. Various vasodilator drugs have also been tried but the basic issues have
to be remedied first to have any chance of success. Some cases of this
condition occur after a definite vasculopathy with focal thrombosis in dermal
vessels presenting with leg ulcers. This variant can be treated with aspirin,
warfarin or low dose heparin.
