Atrophie Blanche: Specific Disease or Physical Finding?

Introduction

Atrophie blanche is a chronic cutaneous manifestation most commonly found on the lower extremity. The lesions are smooth, depressed, ivory white plaques with surrounding hyperpigmentation and telangiectatic capillaries. Atrophie blanche was first described in 1929 by Milian. Milian believed the lesions to be associated with syphilis and tuberculosis. Since then many different authors have considered atrophie blanche a specific diagnosis.

Purpose

We propose that atrophie blanche should be regarded as a term used to describe the characteristic lesion rather than a specific diagnosis.

Methods

This retrospective study was conducted at a large outpatient wound clinic at a tertiary medical center. The data were obtained from the electronic medical records of all new patients seen during the period between November 1996 and March 2007. These patients were evaluated for the presence or absence of atrophie blanche.

Results

Atrophe blanche has an incidence of 9.7% (300 out of 3,096 new patients) in our clinic population.  Venous insufficiency was the most common associated diagnosis (91%).Discussion

Originally described by Milian in 1929, atrophie blanche is considered by many authors as a specific diagnosis. The data from the present study strongly suggest atrophie blanche is simply a physical finding that may be seen in a wide variety of conditions, particularly chronic venous insufficiency. In patients with lower extremity swelling, ulcers, or dermatitis referred to our institution, atrophie blanche was one of the more frequent physical findings, seen in 10% of all patients.  When atrophie blanche is noted on physical exam, chronic venous disease is the most likely associated diagnosis.