Progressive ascending telangiectasia (PAT)

• progressive ascending telangiectasia (PAT) is a rare disease characterized by the development of telangiectatic vessels, initially limited to the feet and ankles, and later spreading up to the legs and onto the trunk and arms
  • the disorder is characterized by the development of telangiectasias which appear initially on the distal lower extremities but slowly and progressively spread to involve the trunk, arms, and face
• women are the most commonly affected, with an average age of onset in the fourth decade of life
• diagnosis is clinical, once other primary and secondary causes of telangiectasias have been excluded
  
• typical evolution makes it possible to distinguish it from the general group of essential telangiectasia
  
  
• systemic treatment with tetracyclines, ketoconazole, and acyclovir has been reported to have been effective in some cases (1,2), and a focal clotting process within the capillaries of the skin, induced by candidal or bacterial endotoxin antigens has been advocated as a pathogenic mechanism (3)
  • only isolated cases treated with each of the above-mentioned drugs have been published, so these cannot be considered as generally accepted treatment measures
  • other therapeutic options include sclerosing therapies, e.g. polydocanol, and pulsed dye laser (585 nm) (3,4)

Reference:

• 1. Shelley WB, Fierer JA. Focal intra-vascular coagulation in progressive ascending telangiectasia: ultrastructural studies of ketoconazole-induced involution of vessels. J Am Acad Dermatol 1984; 10 (5): 876-877
• 2. Shelley WB, Shelley ED. Essential progressive telangiectasia in an autoimmune setting: successful treatment with acyclovir. J Am Acad Dermatol 1989;21(5): 1094-1096.
• 3. Buscaglia DA, Conte ET. Successful treatment of generalised essential telangiectasia with the 585-nm flash lamp-pumped pulsed dye laser. Cutis 2001;67(2): 107-108.
• 4. Seiter S et al. An oculocutaneous presentation of essential progressive telangiectasia.British Journal of Dermatology 1999; 140 (5): 969-971.