Diffuse Dermal Angiomatosis of the Breasts: A Case Series of 8 Patients

Main Article Content

Landon Kaleb Hobbs
Darren Guffy
Hal Flowers https://orcid.org/0000-0003-4618-9630

Keywords

Diffuse dermal angiomatosis, obesity, smoking, fibromyalgia, weight loss, mammoplasty

Abstract

Background: Diffuse dermal angiomatosis (DDA) is a rare, reactive vascular disorder of the skin. Association with vascular disease, smoking, and large pendulous breasts has been reported. No standard of care exists but benefit with medication and reduction mammaplasty has been reported.


Methods: We report a case of a 49-year-old obese female with a history of smoking who presented with DDA that improved with smoking cessation and pentoxifylline prior to reduction mammaplasty. We also performed a retrospective chart review of all patients with DDA seen at our institution between 2010 and 2020.


Results: Eight female patients with DDA affecting the breasts were evaluated at our institution. The mean age was 49.5 years. Five of the patients noted symptoms at presentation. Obesity was seen in 7 (87.5%) patients and 5 (63%) had a smoking history. There was no significant difference between symptomatic and asymptomatic groups in regard to age, t4=-0.63, p=0.56, but BMI trended higher in the symptomatic group, t6=2.27, p=0.06. Three patients (38%) were noted to have fibromyalgia. All symptomatic patients saw improvement in their symptoms with treatments including reduction mammaplasty (1 patient), aspirin (1 patient), pentoxifylline (3 patients), smoking cessation (2 patients), and/or weight loss (1 patient).


Conclusions: Our series is the second largest series of DDA of the breasts and confirms many reported associations including obesity, smoking, and large pendulous breasts. We report the first known case of improvement with weight loss as a sole intervention, as well as identify a novel potential association between DDA and fibromyalgia.

References

1. Yang H, Ahmed I, Mathew V, Schroeter AL. Diffuse Dermal Angiomatosis of the Breast. Arch Dermatol [Internet]. 2006 Mar 1 [cited 2020 Nov 12];142(3). Available from: http://archderm.jamanetwork.com/article.aspx?doi=10.1001/archderm.142.3.343

2. Adams BJ, Goldberg S, Massey HD, Takabe K. A cause of unbearably painful breast, diffuse dermal angiomatosis. Gland Surg. 2012 Aug;1(2):132–5.

3. Touloei K, Tongdee E, Smirnov B, Nousari C. Diffuse Dermal Angiomatosis. Cutis. 2019 Mar;103(3):181–4.

4. Reusche R, Winocour S, Degnim A, Lemaine V. Diffuse dermal angiomatosis of the breast: a series of 22 cases from a single institution. Gland Surg. 2015 Dec;4(6):554–60.

5. Prinz Vavricka BM, Barry C, Victor T, Guitart J. Diffuse Dermal Angiomatosis Associated With Calciphylaxis. Am J Dermatopathol. 2009 Oct;31(7):653–657.

6. O’Connor HM, Wu Q, Lauzon SD, Forcucci JA. Diffuse dermal angiomatosis associated with calciphylaxis: A 5-year retrospective institutional review. J Cutan Pathol. 2020;47(1):27–30.

7. Tollefson MM, McEvoy MT, Torgerson RR, Bridges AG. Diffuse dermal angiomatosis of the breast: Clinicopathologic study of 5 patients. J Am Acad Dermatol. 2014 Dec 1;71(6):1212–7.

8. Galambos J, Meuli-Simmen C, Schmid R, Steinmann LS, Kempf W. Diffuse Dermal Angiomatosis of the Breast: A Distinct Entity in the Spectrum of Cutaneous Reactive Angiomatoses - Clinicopathologic Study of Two Cases and Comprehensive Review of the Literature. Case Rep Dermatol. 2017 Oct 13;9(3):194–205.

9. Frikha F, Boudaya S, Abid N, Garbaa S, Sellami T, Turki H. Diffuse dermal angiomatosis of the breast with adjacent fat necrosis: a case report and review of the literature. Dermatol Online J [Internet]. 2018 [cited 2020 Nov 13];24(5). Available from: https://escholarship.org/uc/item/1vq114n7

10. Azarfar A, Bég S. Diffuse dermal angiomatosis: case report of a distinct skin presentation. Rheumatology. 2020 Jul 12;keaa311.

11. Ursini F, Naty S, Grembiale RD. Fibromyalgia and obesity: the hidden link. Rheumatol Int. 2011 Nov 1;31(11):1403–8.