This is atrophie blanche. Note the smooth ivory white plaque of skin with telangiectasias. It has other names, including lividoid vasculopathy. These areas often ulcerate. It is NOT vasculitis. It is usually excruciatingly painful. The majority of these lesions are associated with venous insufficiency.
I’m not a dermatologist and don’t pretend to be one. The take home points are that it’s associated with thrombosis in the dermal vessels… not vascular inflammation (so prednisone doesn’t help). A subset of patients may have one of the following (but I am not suggesting that you should do a workup for them- it’s just good to have it in the back of your mind): Leiden Factor V, anticardiolipin antibodies, increased homocysteine levels, decreased activity for Protein C, or a positive Lupus anticoagulant.
A host of medications have been tried and sometimes it is trial and error, but treatments include aspirin, Trental, sulfasalazine, dipyridamole and many others. Adelaide Hebert, MD at the University of Texas Health Science Center, Houston, is the first person to suggest trying topical Aczone Gel (topical Dapsone), FDA approved as an acne medication. We reported a small case series in which this topical treatment worked very well. The problem is that it is often not covered by insurance.