Bier anaemic spots, cyanosis with urticaria‐like eruption (BASCULE) syndrome: a new entity?

Bier anaemic spots, cyanosis with urticaria‐like eruption (BASCULE) syndrome on trunk and upper limbs

“…In contrast, histopathologic examination of BASCULE syndrome from an urticaria‐like papule reveals multiple dilated dermal vessels with scattered eosinophils. No damage to the vessel walls of the upper dermis has been described . These histologic findings that Bessis and colleagues described were the same as those observed in our patient.…”

“…Bier anaemic spots, cyanosis with urticaria‐like eruption syndrome is a new dermatosis that Bessis and colleagues described in 2016 (Table ) that is characterized by multiple urticaria‐like red papules on anemic white macules with a surrounding cyanotic background. These variably pruritic lesions are mainly located on the lower limbs . BASCULE syndrome differs from Bier spots in that it also has urticaria‐like papules on the anemic macules.…”

Bascule syndrome associated with syncopal episodes

“…Histologically, in the first report of Bascule syndrome, biopsy was performed in only one patient, and the authors reported multiple dilated capillaries in the dermis, with rare interstitial and scattered eosinophils and mast cells, which was different from the findings in Bier spots . Nevertheless, in this case, biopsy of a red‐orange macule did not show eosinophils or mast cells.…”

“…Bascule syndrome is a recently described benign vasomotor dermatosis characterized by Bier anemic spots, cyanosis, and urticaria‐like eruption . Venous blood pooling induced by orthostatism appears to be the cause of cyanosis.…”

“…The anemic macules have been related to an exaggerated vasoconstrictive response in microvessels, although the lack of venoarteriolar reflex in dermal ascending arterioles may also induce them. Development of the pruritic red‐orange macules suggests a paradoxical urticarial reaction induced by local skin vasoconstriction or hypoxia …”