Case report: A 79-year-old woman presented with a large painful ulcer on the lateral aspect of her left leg over a 6-month period and was diagnosed of ulcerated atrophie blanche. On an outpatient basis punch grafting was performed and 3 weeks after, complete epithelization was achieved. Discussion: Ulcerated atrophie blanche is a misdiagnosed disorder with painful lesions and, consequently, a high impact on quality of life. Atrophie blanche describes porcelain-white colored, red-dotted atrophic plaques on legs or feet. It may be due to multiple causes, usually associated with alterations in the microcirculation. All causes of atrophie blanche can be included in the term livedoid vasculopathy, a type of occlusive vasculopathy without vasculitis. Many patients with atrophie blanche and livedoid vasculopathy have also chronic venous insufficiency. Etiological treatment should be prescribed in order to avoid progression of the lesions. In case of chronic venous insufficiency, control of venous hypertension is essential. Without anti-edema measures, superficial, very painful, and resistant ulcers may appear. These ulcers can be considered a wound on scar tissue; therefore, it must be treated as a hard-to-heal wound. As we show in this case, punch grafting is an effective therapeutic alternative for wound closure and pain reduction of ulcerated atrophie blanche.

中文翻译：

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打孔移植用于治疗溃疡性萎缩性白色萎缩。

病例报告：一名 79 岁女性，左腿外侧出现大片疼痛性溃疡，持续 6 个月，被诊断为溃疡性白色萎缩症。在门诊进行打孔移植，三周后，实现了完全上皮化。讨论：溃疡性白色萎缩是一种被误诊的疾病，具有疼痛性病变，因此对生活质量影响很大。白色萎缩症是指腿部或足部出现瓷白色、红点状萎缩斑块。这可能是由多种原因造成的，通常与微循环的改变有关。所有引起白色萎缩的原因都可以包含在青斑样血管病这一术语中，这是一种不伴有血管炎的闭塞性血管病。许多患有白色萎缩和青斑血管病的患者还患有慢性静脉功能不全。应进行病因治疗以避免病变进展。在慢性静脉功能不全的情况下，控制静脉高压至关重要。如果不采取抗水肿措施，可能会出现浅表、非常疼痛和顽固性溃疡。这些溃疡可以被认为是疤痕组织上的伤口；因此，必须将其视为难以愈合的伤口。正如我们在本例中所展示的，打孔移植是一种有效的治疗替代方案，可用于闭合伤口和减轻溃疡性萎缩性白色萎缩的疼痛。