Atrophie blanche usually appears as painful purpuric papules that evolve into ulcerations and, finally, angular scars on the lower extremities. The literature on this subject presents a confusing picture of its causes, pathogenesis, and treatment. From our review of the literature and our experience in evaluating and treating cases of atrophie blanche, we conclude that it is best categorized as a clinicopathologic entity with multiple causes. Its characteristic histopathologic features and clinical evolution indicate that the common pathologic event is occlusion of vessels in the middle and deep dermis. No single form of therapy has been consistently effective for the treatment of atrophie blanche, but drugs that inhibit platelet thrombus formation or stimulate endogenous fibrinolytic activity arrest the disease in most patients.