eMedicine Specialties > Gastroenterology > Systemic Disease

Malignant Atrophic Papulosis: Treatment & Medication

Author: L Campbell Levy, MD, Fellow, Section of Gastroenterology and Hepatology, Department of Internal Medicine, Dartmouth Hitchcock Medical Center
Coauthor(s): 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; Brian E Lacy, MD, PhD, Associate Professor of Medicine, Dartmouth Medical School; Director of GI Motility Laboratory, Department of Gastroenterology, Dartmouth Hitchcock Medical Center; Hemant Pande, MD, Consulting Staff, Department of Gastroenterology, Leesville Surgical Clinic and Digestive Disease Center; Lawrence Cheskin, MD, Chief, Associate Professor, Department of Medicine, Division of Gastroenterology, Bayview Medical Center, Johns Hopkins University School of Medicine
Contributor Information and Disclosures

Updated: Aug 29, 2006

Treatment

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 neurological 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 MAP, 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.

Surgical Care

  • Surgical treatment usually is required for patients who develop complications such as gastrointestinal bleeding, intestinal perforation, bowel infarction, or intracranial bleeding.

Consultations

  • Dermatologists
  • Gastroenterologists
  • Neurologists
  • General surgeons
  • Neurosurgeons
  • Rheumatologists
  • Ophthalmologists

Diet

No special diet is required.

Activity

No restriction of physical activity is required.

Medication

To date, no medications have proven beneficial in the treatment of MAP.

More on Malignant Atrophic Papulosis

Overview: Malignant Atrophic Papulosis
Differential Diagnoses & Workup: Malignant Atrophic Papulosis
Treatment & Medication: Malignant Atrophic Papulosis
Follow-up: Malignant Atrophic Papulosis
References
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References

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Further Reading

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Keywords

MAP, Kohlmeier-Degos syndrome, Degos disease, vascular occlusive disorders, thromboangiitis obliterans

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

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.

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 Motility Society, and American Society for Gastrointestinal Endoscopy
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.

Lawrence Cheskin, MD, Chief, Associate Professor, Department of Medicine, Division of Gastroenterology, Bayview Medical Center, Johns Hopkins University School of Medicine
Lawrence Cheskin, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

Medical Editor

David Eric Bernstein, MD, Chief, Section of Hepatology, North Shore University Hospital, Director, Associate Professor, Department of Internal Medicine, Division of Hepatology, New York University School 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, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Douglas M Heuman, MD, FACP, Director of Hepatology, McGuire Veterans Affairs Medical Center, Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine
Douglas M Heuman, MD, FACP is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
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 and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

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