title: Diffuse dermal angiomatosis of the breast: a series of 22 cases from a single institution.
abstract: BACKGROUND
  Diffuse dermal angiomatosis (DDA) is a rare cutaneous disorder that can affect the breast. A total of nine cases of breast involvement have been described in the literature, but there is currently no consensus in the best therapeutic approach. The objective of this study was to examine patient outcomes with such therapies in women diagnosed with DDA of the breast.
  
  
  METHODS
  Consecutive cases of DDA of the breast were retrospectively reviewed including patient demographic variables, diagnostic criteria and type of therapies. A successful outcome was defined as complete healing of chronic open breast wounds and absence of disease recurrence after cessation of therapy.
  
  
  RESULTS
  Twenty-two women (mean age, 48.4 years) diagnosed with DDA of the breast were identified between 2004 and 2012. The diagnosis was confirmed with skin biopsy in 12 patients and clinical diagnosis in the remaining ten patients. The majority of patients were obese [68.2% (15/22), average body mass index (BMI), 36.9 kg/m(2)] and at the time of diagnosis, 27.3% of patients were active smokers (6/22). Only two patients (9.1%) received isotretinoin, neither had full recovery and both patients showed recurrence when taken off of therapy. Other medical therapies showed less to no improvement. Two patients underwent successful surgical treatment. One patient had a successful outcome following breast reduction, although her postoperative course was complicated with delayed wound healing. The other patient presented with recurrence of DDA following breast reduction, and was successfully managed with bilateral simple mastectomies.
  
  
  CONCLUSIONS
  Our findings suggest that DDA of the breast is associated with macromastia, obesity and tobacco use. Isotretinoin therapy is published as having favorable outcomes to other therapies, but in this series only appears to reduce symptoms rather than eradicate DDA. Our findings indicate that other medical therapies have been attempted with limited success. Surgical management of DDA of the breast may provide definitive treatment.
authors.affiliation: 1 Division of Plastic Surgery, 2 Division of General and Gastroenterologic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Reusche
authors.affiliation: 1 Division of Plastic Surgery, 2 Division of General and Gastroenterologic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Winocour
authors.affiliation: 1 Division of Plastic Surgery, 2 Division of General and Gastroenterologic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Degnim
authors.affiliation: 1 Division of Plastic Surgery, 2 Division of General and Gastroenterologic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Lemaine
keywords: Breast; case series; diffuse dermal angiomatosis (DDA)