de Godoy Journal of Medical Case Reports 2010, 4:295 http://www.jmedicalcasereports.com/content/4/1/295 C A S E R E P O R T Treatment of stasis dermatitis using aminaphtone: a case series José Maria Pereira de Godoy Abstract JOURNAL OF MEDICAL CASE REPORTS Open Access Introduction: Stasis purpura is a common finding in clinical practice and is related to vascular alterations. Case presentation: Four randomly-selected, Caucasian patients (a 45-year-old woman, a 26-year-old man, a 51-year-old man and a 56-year-old woman) were treated with aminaphtone for approximately one year. For all patients, the brown patches - a sign of stasis purpura - disappeared without the appearance of new lesions within this period. Conclusion: Aminaphtone is a novel proposal in the treatment of stasis purpura when capillary fragility is identified. Introduction Chronic venous disease (CVD) is common with manifes- tations that include varicose veins, skin changes such as dermatitis, hyperpigmentation, lipodermatosclerosis, and chronic leg ulcers [1]. Venous stasis disease is involved in 70 to 90 percent of all lower-extremity ulcers treated. Venous hypertension, due to inadequate venous return associated with a defective valvular system, is the main culprit [2]. Lipodermatosclerosis is an indurated plaque in the medial malleolus that can, at times, be quite tender and painful [1,3]. Venous dermatitis is often the first manifestation of venous insufficiency and needs to be addressed promptly [3]. Hemosiderin and/or melanin have been considered responsible for the brown pigmentation [4]. On histopathologic evaluation, dermal melanocytes con- taining melanin and incontinence of melanin pigment were observed, which suggests that melanin pigment from the epidermis may contribute to cutaneous pig- mentation in stasis dermatitis [4]. There is a scarcity of therapies to treat stasis dermatitis recorded in the litera- ture; however, the use of substances that control capil- lary fragility may be useful to control bleeding [5]. Capillary fragility is a condition where the smallest blood vessels, the capillaries, become weak and may Correspondence: godoyjmp@riopreto.com.br The Angiology and Vascular Surgery Service of the Medicine School in São José do Rio Preto, FAMERP, Rua Floriano Peixoto 2950, São Paulo, Zip code 15010-020, Brazil rupture, leaking blood into the surrounding tissues. This bleeding is identified initially by small reddish puncti- form spots or petechiae which become brown with time. My aim in this case report is to describe the long- term use of aminaphtone in the treatment of stasis pur- pura when capillary fragility is identified. Case presentation Case 1 A 45-year-old Caucasian woman presented with brown patches on the lower third of her leg, which had been present for three years prior to our interview. She reported no other clinical complaints. She described that the lesions started as small reddish spots which became brown over time. A physical examination con- firmed that the brown patches were associated with red- dish punctiform petechiae. Additionally, clinical, etiology, anatomic and pathophysiology (CEAP) 1 telan- giectasia was observed. A clinical diagnosis of stasis pur- pura was reached and she was medicated with 75 mg aminaphtone, twice daily for one year, resulting in a complete remission of the lesions. No new punctiform lesions appeared during a three-year follow-up period. Case 2 A 26-year-old Caucasian man presented with a history of brown patches on both legs that had started two years previously with the appearance of reddish spots. On physical examination, the presence of brown patches © 2010 de Godoy; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.