CASE REPORT
Schamberg's disease is a pigmented purpuric dermatosis
characterized by petechial hemorrhage believed to be
secondary to capillaritis.1 Patients are generally asymptomatic, often seeking treatment for cosmetic reasons. Many
treatments have been proposed, including topical and oral steroids, pentoxifylline, 2 griseofulvin,3 psoralen and UVA,4 narrow
band UVB,5 oral bioflavonoids and ascorbic acid,6 colchicine,7
and others. No single treatment has proven to be consistently
effective, and most have the possibility of systemic side effects.
We report five cases of clinically diagnosed Schamberg's disease treated with advanced fluorescence technology (AFT)-a
new-generation pulsed light based handpiece.
Three male patients and two female patients, aged between
65 and 84 years (mean 72.4 years), presented with pigmented
purpuric eruptions on the lower extremities that were clinically
characteristic of Schamberg's disease (Table 1). All of these patients had stable disease for at least six months, with no change
in quantity or quality of eruptions. They were all asymptomatic
and sought therapy for cosmetic purposes. Four of the patients
were treatment naÏve, while one had previously failed treatment with fluocinonide 0.05% cream. The treatment consisted of
pulsed light therapy using a 570 nm AFT handpiece with fluence
of 12 to 14 J/cm 2 , and pulse width of 12 to 15 ms (Harmony XL;
Alma Lasers). Treatments were performed in 4 to 6 week intervals until patient satisfaction was achieved. No other therapies
were used. All five patients responded favorably to therapy and
achieved cosmetic satisfaction in 1 to 3 treatments with no reported adverse events. No recurrences were observed after 6
months of follow up.
The pigmented purpuric eruptions of Schamberg's disease
classically involve the lower extremities and are characterized as yellow-brown oval or irregular patches with overlaying
red-brown "cayenne-pepper" macules.1 Histopathology usually demonstrates perivascular infiltrates of lymphocytes and
macrophages, extravasations of erythrocytes, and variable hemosiderin within macrophages.8
Intense Pulsed Light (IPL) devices are versatile and have been
used for vascular lesions, hair removal, pigmented lesions, photodynamic therapy, and photorejuvenation. Vascular lesions are
treated via selective absorption of IPL by hemoglobin within
vessels, which generates heat and induces localized thermal
damage.8 We hypothesized that AFT could similarly improve
the cosmetic appearance of Schamberg's disease eruptions by
selectively targeting hemosiderin within macrophages and hemoglobin within extravasated erythrocytes.
The 570 nm AFT handpiece with its moderate fluence and optimal pulse width were found to be amendable and safe for the
treatment of Schamberg's disease. Settings may need adjustments according to the patient's skin type, and patients should
always undergo a test spot to assess for adverse effects prior
to treatment. Increasing the fluence could potentially improve
efficacy, but it also augments the risk of adverse outcomes. Between treatments, patients may have streaks of untreated areas
that stand out. These areas should be specifically targeted in
subsequent treatments to obtain more homogenous cosmetic
results. We found no side effects such as blistering and pigmentary alterations in any of our patients.
