By Gary M. White, MD
Telangiectasia macularis eruptiva perstans (TMEP) is a variant of mastocytosis in which telangiectatic macules are the presenting sign. They often occur on the trunk of a woman. Special stains may be needed to help identify the mast cells histologically.
Clinically, one sees 5-10 mm pink/brown telangiectatic macules, predominantly on the trunk. Itching may vary from mild to intense. Gentle scratching may elicit the Darier sign.
Workup should include a CBC and tryptase to assess for systemic involvement. Any abnormality should prompt a referral to Hematology/Oncology.
A potent topical steroid may be very effective. For example, clobetasol 0.05% cream applied to one section of the body QD for one month can nearly clear lesions. Then move on to another section of the body, while applying maintenance to the initial area (e.g., initially once a week, tapered to once a month). It is important to not coat the whole body daily with a potent topical steroid so as not to suppress the hypothalamic-pituitary-adrenal (HPA) axis. In addition, it is important to avoid prolonged daily use of such a potent topical steroid in one area as it may induce atrophy and telangiectasias.
The 585-nm flashlamp-pumped dye laser cleared all treated lesions without scarring after one treatment in one study [DermSurg 1996;22;33]. Doxepin given preoperatively and postoperatively provided the best mast cell mediator blockade. Its effects seem to be secondary to reducing the vasculature and not via a direct effect on the mast cells.
Any itching should be treated with a non-sedating antihistamine.
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