Schamberg's Disease

DEFINITION: Schamberg's disease is a condition in which there is multifocal extravasation (leakage) of blood in a distinctive pinhead pattern on the skin of the lower or upper extremities (legs and sometimes arms). This leakage of blood cells is due to nonspecific inflammation of very small blood vessels called capillaries. Essentially, for unknown reasons, probably viral, the capillaries become inflamed and leak. The condition is not cancerous. Schamberg's disease is a "capillaritis" which is inflammation of the capillaries.

PRESENTATION: Schamberg's capillaritis results in many reddish points of bleeding beneath the skin, resembling grains of Cayenne pepper. One refers to Cayenne pepper spotting. The distribution of pinpoint bleeding spots is in irregular patches over the leg, shin, and ankle skin surfaces, with a tendency for extension proximally towards the trunk. The patchy points seldom itch, and are rarely symptomatic. No one knows the exact cause for the disease.

COURSE: Over time, the initial pinpoint spots of subdermal bruising fade into the surrounding pigmented patches as the extravasated red cells are broken down and their content is turned into hemosiderin, a by product of the hemoglobin. The inflamed capillaries which had been dilated and swollen with degenerated cells of the capillary walls gradually recover. The condition resolves spontaneously over several months.

DIAGNOSIS: Because of its characteristic presentation and distribution, Schamberg's disease is rarely confused with other types of capillaritis which may occur in the same areas. The diagnosis of Schamberg's disease can be confirmed by biopsy.

THERAPY: Many dermatologists suggest the use of topical steroids in a trial of four to six weeks to speed up the resolution. The condition may always recur, and the color changes may take years to resolve. Dr. Jacobs suggests ABC moisturization.