LAUSR

CPC03 Generalized essential telangiectasia response to treatment with oral dabigatran: a case report Elian Karim, Anna Ascott, Christine Aziz and Arjida Woollons Brighton & Sussex Medical School, Brighton, UK; and University Hospitals Sussex NHS Foundation Trust, Shoreham-by-Sea, UK A 52-year-old white woman presented in 2013 with asymptomatic telangiectasia on her lower limbs. She was systemically well with no other medical history and no family history of telangiectasia. Examination at the time showed blanching telangiectasia localized below her knees, bilaterally more confluent around her feet and ankles. Blood tests showed normal inflammatory markers, immunoglobulins, autoimmune screen, cryoglobulins, antinuclear antibodies and anticardiolipin antibodies. Skin biopsies taken from representative areas showed prominent telangiectasia of superficial dermal vessels with minor perivascular chronic inflammatory cell infiltrate. There was no evidence of vasculitis. She re-presented in 2017 as the telangiectasia had progressed to her thighs and forearms. Repeat blood tests were normal and skin biopsies showed histology similar to 2013. A diagnosis of generalized essential telangiectasia (GET) was made. She was referred for laser treatment. She had five cycles of intense pulsed light laser to small representative areas. She found the treatment painful and the treated areas subsequently recurred. She re-presented again in 2021 with marked progression of the telangiectasia, affecting almost her entire body surface, sparing her head and neck. Repeat blood tests were, again, unremarkable. Ultrasound of the lower limbs noted competent arterial, deep venous and superficial venous systems bilaterally. Skin biopsies showed dilated vessels; there was subtle hyaline thickening, a characteristic of cutaneous collagenous vasculopathy (CCV). These two conditions are clinically indistinguishable but are differentiated on histology. Overall histological evidence was not enough to support CCV and was more in keeping with GET. She was commenced on oral doxycycline 100 mg twice daily for 3 months with no improvement. She developed paroxysmal atrial fibrillation and was commenced on oral dabigatran by her cardiologist. Her widespread telangiectasia faded dramatically after only a few weeks of dabigatran, with no further progression seen. She continues to be on dabigatran. GET is a rare, benign, idiopathic disorder categorized by widespread permanent dilation of the cutaneous capillaries. The condition often presents with asymptomatic telangiectasia that starts in the distal lower limbs and progress to the upper limbs. In some cases, tingling and numbness may be present. Available treatments are mostly cosmetic and involve the use of cover-up cosmetics or self-tanning lotions to hide the telangiectasia. Laser therapy has become the treatment of choice, although evidence of its efficacy in literature is variable, and its costly and painful nature often disrupts compliance. There are anecdotal reports of response to oral tetracyclines. To the best of our knowledge, treatment of GET by dabigatran has not previously been described. The rapid and striking improvement seen in our patient following dabigatran suggests anticoagulants may be a potential treatment option for this rare and difficult-to-treat condition.