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An 8 years old girl presented with multiple persistent grouped vesicles
over right thigh since infancy. She was born with few vesicles only but
developed more such lesions later on. There was intermittent spontaneous
and traumatic discharge of both clear and hemorrhagic fluid from the
lesions. Rest of the history was unremarkable. On examination, multiple
grouped vesicles were seen in zosteriform pattern over right thigh (Fig
1). Most of the vesicles were discrete, tense and red black. Few
fresh vesicles containing clear fluid were seen. They were smaller and
were slightly yellowish. Rest of the mucocutaneous examination was
unremarkable. Based on history and clinical findings, diagnosis of
lymphangioma circumscriptum was made.
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Fig. 1 Multiple grouped red black coloured
vesicles over right thigh. Note fresh vesicles (encircled). |
Lymphangioma circumscriptum is a microcystic lymphatic
malformation that is localized to an area of skin, subcutaneous tissue &
sometimes, muscle. It usually presents with persistent clustered vesicles
containing clear fluid. The vesicles may be discrete or may be grouped
into structures resembling "frog spawn". It may appear red-black when they
contain blood, a frequent finding. Common differential diagnoses include
herpes simplex (usually has a prodrome of fever), herpes zoster
(associated with pain and burning sensation at lesional site) and
angiokeratoma circumscriptum (verrucous papules, more frequent history of
bleeding). Treatment of choice is radical surgery.
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