ATROPHIE BLANCHE
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I've inherited a 78y.o. lady with a 20 year hx of extensive 
bilateral atrophie blanche. Her work-up has been partial at best 
(mildly elevated sed rate; negative cbc/panal/cryoglobulin screen/RA 
latex/ANA....
        Question #1: should I spend a few hundred more testing for 
Lupus anticoagulant?  Phospholipid antibody? Cryofibrinogen?
        Question #2: What, of all the things tried, would be *your* 
favorite Rx?  The list is long:
        ASA/Pentoxyphyline/dipyridamole/phenformin + 
estrogen/sulfinpyrazone 
(Anturane)/Sulfasalazine/Ticlid/nifedipine/nicotinic 
acid.../stanazolole (sic)....

Mike Eichwald 
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Within the past several  months there was a paper on Danazole and
their successes, I think 2 patients, were quite amazing. I am not big on
this variety of drug at all, but alot of the other drugs listed had been
tried, including our faavorite Trental. Though I don't think they doubled
the dose as someone has suggested here. Has she had mini strokes etc that
might point towards a antiphospholipid syndrome? Also, if she can hit the
lesions very early with ultrapotent steroids she may prevent ulceration.

Diane Thaler
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 This year at a conference in Scotland I saw a patient with
atrophie blanche from cryofibrinogenemia who had an excellent response to
stanozolol.  I would check for cryofibrinogens, and consider a trial of
stanozolol.  There is an excellent, short, practical article on stanozolol
in JAAD August 1995,33,p. 254-258.  I am considering a trial of it in a
patient with hypodermitis scleridermiformis that I am at the end of the
therapeutic line with.  
 
Claire L. Haycox, M.D., Ph.D.
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You can inject a few of the worst areas with Kenalog 3 or 6 mg / ml as a 
test
- if this works use more in a month.

I've found Trental / ASA / Stanazolol all somewhat disappointing, but not
useless. 

I recall my best successes with EC Sulfasalazine 500 mg - 2 po tid (plus any
or all of the above.)

KC Smith MD FRCPC
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Good results in several cryoprotein associated ulcers with Stenazolol at 
UM/Jackson Memorial.

Michael Fetterman
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