To the Editors:Tufted angioma was first described in 1989 by Wilson Jones and Orkin (1) as a distinct vascular lesion that is characterized by circumscribed lobules of hypertrophied capillaries with a pericyte component. Tufted angiomas most commonly arise on the neck and upper trunk in young persons. Over half of patients develop the lesions within the first 5 years of life, and only three patients previously reported have had lesions at birth. These lesions typically undergo a growth phase, characterized by lateral extension, for 5 months to 10 years (2). Treatment of tufted angioma is usually unsatisfactory. Recently Suarez et al.(2) reported a good response to treatment with interferon alfa. Despite low initial levels of urinary bFGF, a successful trial of interferon alfa was initiated. We report a patient with a tufted angioma and elevated urinary bFGF who underwent a trial of interferon alfa. The patient demonstrated a marked decrease in urinary bFGF levels, but no clinical response. This observation indicates that other growth factors in addition to bFGF contribute to the development of tufted angiomas.A 12-year-old white girl presented for evaluation of a congenital lesion involving her right thigh. The lesion had significantly increased in size over a 2-year period. The patient had no additional past medical history. On physical examination, a 15 cm x 15 cm, nontender, purple plaque was present on the right anterior and lateral thigh and knee. Both limbs were of equal circumference. No bruits or thrills were detected at the site. A biopsy specimen of the lesion revealed focal collections of tightly packed capillaries throughout the dermis. Multiple rounded lobules of poorly canalized capillary channels were widely distributed. Baseline MRI revealed vascular proliferation limited to the subcutaneous fat without extension into the muscle layers, synovial space, or bone structure. However, the subcutaneous fat layer was enlarged as a result of increased vascular volume present in the area.The patient was referred to hematology/oncology for a trial of interferon alfa. Baseline urinary bFGF level was 4500 pg/g Cr. She received a total course of 12 weeks of daily subcutaneous injections of interferon alfa 2 to 3 Mu/m2 without significant change in the size of the lesion over a 3-month period. Two urinary bFGF levels of less than 500 pglg Cr were obtained while the patient was on treatment, which were significantly less than her baseline level.Many treatments have been used for tufted angioma, including surgical excision, x-ray therapy, dye laser, cryosurgery, and electrocautery, all of which have been associated with recurrences of the lesion (2). Treatment with topical or intralesional corticosteroids has been reported to have no effect. Interferon alfa has been shown to dramatically decrease the size of cutaneous hemangiomas in expanding lesions (3), and Suarez et al.(2) applied this therapy successfully in the treatment of tufted angioma. In addition to this case, there is one further case of successful tre...
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