Javorka Delic, Vesna Mikulic Angiology Department City Institute of Dermatology Belgrade, Serbia

1. Dermoscopy
diagnostic method of
microangiopathy in
chronic venous ulceration
Javorka Delic, Vesna Mikulic
Angiology Department
City Institute of Dermatology
Belgrade, Serbia

2. Microangiopathy
Microangioathy in postthrombotic chronic
venous ulceration (CVU).
Microangioathy is the consequence of
venous hypertension,venous stasis,
chronic inflammation,ulcerations and
reparative processes.

3. The aim of this study
Objective: The presentation of the blood
wessels and pigmentation of the papilar
dermis by dermoscopy HEINE, Delta 20.
57 patients, with CVUs,
which were confirmed by clinical and Color
Duplex Exams.
The group consists of 32 female, 25 male
with fotodocumentation–clinic image,
dermoscopy.

4. Results
Venous capillares in papilar dermis:
dilated, derformed, like lacuna, individual or
grouped in globula formation and often, in
formation like pomegranate (more globula)
which are localised near of the ulcerations.
On places of atophy or sclerosys there werent
visible blood wessels and the pigment
deposits

5. Results
Pseudo–network
Localised near of
ulceration,(hemosiderin,melanine) present the
residual pigmentation in stasis dermatitis.
Also, pseudo-network is a sign of the
phenomena of lowering melanine
in deeper leyer beacouse of the disturbance of
basal membrane and epidermal barrier.

6. Results
Pappering
Maccular pigmentation is a very tipical
finding the sign of the increasing
acitivities of the macrophags usually
increasing in lymphoedema, inflammation,
infection.
Pappering was the most enlarges on zones
near the cicatrix.

7. Case report 1
Men,62 years.
Posttrombotic synd. sin.
Color Duplex: Insuff.VSM, VV perf.
V.Poplitea,VV tib.post.Repetative ulcerations.
Dermoscopy: Pseudo-network on the limb left
(residual pigmentation,brown color), defect of
the tissue dilated bood wessels in papilar
dermis, in formation globula.

8. Case report 1
Dermoscopy finding

9. Case report 1
Dermoscopy finding

10. Clinic image
Case report 1

11. Women 60 years. Synd postthromboticum
cr dex.Repetative ulecrations . Color
Duplex: Insuff VSM dex,VV perf dex,
med, inf., Insuff VV tib post.VV Peronealis.
Dermoscopy: Pseudo-network ,brown color
near of the blood wessels. White areae
(cicatrix). Blood wessels as lacuna like and
Pomegranate (more globuls) .
Case report 2

12. Case report 2
Dermoscopy finding

13. Dermoscopy finding
Case report 2

14. Case report 2
Clinic image

15. Women, 32 years.
Posttrombotic syndrome cr sin.
Color Duplex: Insuffitientia VSM and VV reforantes
cr in med. V.poplitea sin. Repetative ulcerations.
Dermoscopy: Dillated wessels in globula
formation, near the healed wound; residual
pigmentation in papilar dermis( dark color),
macular white fibrin tissue (atrophy of the
skin);
Case report 3

16. Case report 3
Dermoscopy finding

17. Case report 3
Dermoscopy finding

18. Case report 3
Clinic image

19. Diagnostic method
Dermoscopy as a diagnostic method of the
microangiopathy, is representing different
residual pigment deposits in papilar
Dermis disturbance of blood wessels as
lakuna, globulas, pomegranate atrophy and
sclerosis of the skin.

20. CONCLUSION
The type of skin has influence on the resultats
(Fitz–Patrick)
sex (estrogen depended pigmentation) but the
most importante influence have the
stadium of disease (C5 and C6).
Dermoscopy is adjuvante and very confortable,
not expansive method.
For examination of micocircultion state in
chronic venous insuffitienty.
Key words: Dermoscopy, chronic ulceration,
pigmentation, blood wessels.

21. Dermoscopy - diagnostic
method of microangiopathy in
chronic venous ulceration
Prim. Dr. Javorka Delic
drdelic@orion.rs
President of Serbian
Wound Healing Society