Acral pseudolymphomatous angiokeratoma of children
APACHE is more common in females than males. Adult-onset cases have also been described. The clinical appearance of lesions varies. They most commonly appear as asymptomatic, unilateral, erythematous or violaceous angiomatous papules on an acral region, but they have been observed on the arm and leg. Papules are often clustered but may be solitary, linear, or coalescing into a plaque. There has been 1 reported case with accompanying nail plate dystrophy.
Without treatment, the lesions of APACHE will persist; however, treatment is not necessary given its benign nature.
D23.9 – Other benign neoplasm of skin, unspecified
402842008 – Acral pseudolymphomatous angiokeratoma of children (APACHE)
Differential Diagnosis & Pitfalls
- Angiokeratoma of Mibelli – Dermoscopy will show characteristic round lacunae and a whitish veil.
- Lymphangioma circumscriptum
- Viral warts
- Intradermal nevus
- Spitz nevus
- Lichen planus-like keratosis
- Kaposi sarcoma
- Pyogenic granuloma
- Histopathologically, consider cutaneous B- or T-cell lymphoma or angiosarcoma.