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D.H. McGibbon, BASCULE syndrome: old wine in new bottles?, British Journal of Dermatology, Volume 175, Issue 5, 1 November 2016, Pages 1109–1110, https://doi.org/10.1111/bjd.14898
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Funding sources: none.
Conflicts of interest: none declared.
Dear Editor, Bessis et al.1 describe what they believe to be a new syndrome, Bier anaemic spots associated with cyanosis with urticaria‐like eruption (BASCULE) syndrome. In doing so they have provided a nice description and beautiful pictures of orthostatic acrocyanosis (OA).2 They describe four cases, three of whom triggered the eruption after standing and one by mechanical pressure. There was a uniform background cyanosis in which pink macules were scattered. In the centre of some of these pink macules, pinpoint to 1–2‐mm papules are seen.
In my experience of OA the central papules are common and the pain/pruritus is variable but may be intense. All of these features reverse within minutes on sitting. Occasionally I have observed increased sweating as well. The condition is usually but not always associated with postural orthostatic tachycardia syndrome (POTS).
The common mistake is for OA to be diagnosed as livedo reticularis, but here the cyanosis is reticulate, not uniform, and the centre is pale not pink and there is no central papule.
