title: Lichen aureus: a hemosiderin tattoo associated with perforator vein incompetence.
abstract: We present evidence that lichen aureus results from extravasation of red blood cells into the dermis caused by incompetence of an underlying perforator vein. The sudden appearance of the lesion suggests a "blow out" of the microvasculature of the lower dermis caused by failure of the valves in the perforator vein. This incompetence of the perforator vein induces a permanent reversal in normal blood flow. The consequent continuous high pressure in the cutaneous microvasculature is responsible for long-term leakage of red blood cells. Digestion of the extravasated red cells by macrophages leaves an "auto-tattoo" of insoluble hemosiderin granules, which produce the distinctive golden or burnt orange color of lichen aureus.
mesh_terms: D000328:Adult; D000368:Aged; D004912:Erythrocytes / Q000378:metabolism; D006485:Hemosiderin / Q000378:metabolism; D006801:Humans; D008010:Lichen Planus / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010859:Pigmentation Disorders / Q000209:etiology* / Q000473:pathology; D013848:Thigh / Q000098:blood supply; D014680:Veins / Q000503:physiopathology
chemical_list: D006485:Hemosiderin