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Malignant Atrophic Papulosis Treatment & Management

  • Author: L Campbell Levy, MD; Chief Editor: BS Anand, MD  more...
Updated: Jun 17, 2016

Approach Considerations

In severe cases, the patient may need to be admitted for a diagnostic evaluation to determine the extent of disease and to exclude other vasculitides such as systemic lupus erythematosus (SLE) or polyarteritis nodosa (PAN). Malignant atrophic papulosis should be considered in patients diagnosed with a nonspecific vasculitis that does not respond to immunosuppressive therapy.

Admit the patient to the hospital immediately if a complication such as gastrointestinal bleeding, perforation, or stroke is suspected. Transfer may be required for surgical intervention in those patients who develop peritonitis or intracranial bleeding. (Surgical treatment usually is required for patients who develop complications such as gastrointestinal bleeding, intestinal perforation, bowel infarction, or intracranial bleeding.)

Broad-spectrum antibiotics may be used in patients with intestinal perforation in the perioperative period. Discontinuation of prothrombotic medications (eg, oral contraceptives) should be considered.

Monitor patients with isolated cutaneous disease for the development of systemic disease.


Medical Care

Because most patients initially present with skin manifestations, they typically are seen by a dermatologist, at which time a diagnosis usually is made. The skin lesions are not painful, usually do not itch, and generally do not require treatment. Patients who have gastrointestinal or neurologic symptoms should undergo an appropriate workup to detect systemic disease, which is an important determinant of prognosis.

Many medications have been tried for treatment of malignant atrophic papulosis, without consistent success. Degos suggested that anticoagulants might be effective, but others have shown them to be of no benefit. Isolated cases of benign cutaneous disease have responded to nicotine patches (5 mg/d transdermal patch) and pentoxifylline plus aspirin. Similarly, antiplatelet drugs, such as aspirin and dipyridamole, may reduce the number of new papules but have not shown any consistent benefit in systemic disease. Other drugs (eg, corticosteroids, immunosuppressants, sulfonamide, tetracycline, penicillin, interferon 2 alpha) have been shown to be ineffective in altering the course of the disease.

No special dietary or activity considerations are necessary.

Consider consultations with the following specialists:

  • Dermatologists
  • Gastroenterologists
  • Neurologists
  • General surgeons
  • Neurosurgeons
  • Rheumatologists
  • Ophthalmologists
Contributor Information and Disclosures

L Campbell Levy, MD Fellow, Section of Gastroenterology and Hepatology, Department of Internal Medicine, Dartmouth Hitchcock Medical Center

L Campbell Levy, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.


Lawrence J Cheskin, MD Director, Johns Hopkins Weight Management Center; Associate Professor, Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health; Joint Appointment, Department of Medicine, Division of Gastroenterology, Johns Hopkins University School of Medicine; International Health/Human Nutrition, JH Bloomberg School of Public Health

Lawrence J Cheskin, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association

Disclosure: Received consulting fee from Medifast for board membership; Received none from Vivus for purchase of stock as an investment; Received none from Medifast for purchase of stock as an investment.

Brian E Lacy, MD, PhD Associate Professor of Medicine, Dartmouth Medical School; Director of GI Motility Laboratory, Department of Gastroenterology, Dartmouth Hitchcock Medical Center

Brian E Lacy, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

David Eric Bernstein, MD Director of Hepatology, North Shore University Hospital; Professor of Clinical Medicine, Albert Einstein College of Medicine

David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.


Robert J MacNeal, MD Staff Physician, Department of Dermatology, Critical Care Fellowship Reviewer, Dartmouth-Hitchcock Medical Center; Supervising Medical Officer, Veterans Administration Hospital, White River Junction, Vermont

Robert J MacNeal, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Hemant Pande, MD Consulting Staff, Department of Gastroenterology, Leesville Surgical Clinic and Digestive Disease Center

Hemant Pande, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

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