70 - Anetoderma and Other Atrophic Disorders of the Skin

Question 1

The lesions in anetoderma usually occur in _____ and more often in _____

Answer 1

Young adults between the ages of 15 and 30 years

Women than men

Question 2

Anetoderma can be associated with various systemic conditions, primarily

Answer 2

Antiphospholipid antibodies

Question 3

Characteristic lesions are flaccid circumscribed area of slack skin with the impression of loss of dermal substance forming depressions, wrinkling, or sac-like protrusions

Answer 3

Anetoderma

Question 4

Examining finger sinks without resistance into a distinct pit with sharp borders as if into a hernia ring

Answer 4

Buttonhole sign

Question 5

Most common sites for anetoderma

Answer 5

Chest
Back
Neck
Upper extremities

Question 6

Types of anetoderma

Answer 6

Primary - no underlying associated skin disease

Secondary - atrophic lesions has appeared in the exact same site as a previous specific pathology

Question 7

Types of primary anetoderma

Answer 7

1. Those with preceding inflammatory lesions, mainly erythema (Jadassohn-Pellizzari type)
2. Those without preceding inflammatory lesions (Schweninger-Buzzi type)

Question 8

Most common causes of secondary anetoderma

Answer 8

Acne

Varicella

Question 9

Both primary and secondary types of anetoderma may be associated with an underlying disease, mainly

Answer 9

Antiphospholipid syndrome
Autoimmune thyroiditis
HIV

Question 10

Predominant defect in anetoderma

Answer 10

Focal partial or complete loss of elastic tissue in the papillary and/or midreticular dermis

Question 11

Acquired disorder characterized by white, firm nonfollicular papules measuring 1 to 3 mm, evenly scattered on the chest, abdomen and back
Pathology demonstrates focal degeneration of elastic fibers

Answer 11

Papular elastorrhexis

Question 12

Papular elastorrhexis is differentiated from anetoderma by being

Answer 12

Firm, noncompressible lesions

Question 13

Characterized by patches and plaques of diffuse, fine, wrinkled skin, most often on the trunk, neck and arms

Answer 13

Middermal elastolysis

Question 14

Types of middermal elastolysis

Answer 14

1. Asymptomatic, well-demarcated, or diffuse areas of fine wrinkling (Type I)
2. Discrete perifollicular papules (Type II)
3. Reticular pattern (Type III)

Question 15

Elastic tissue stains

Answer 15

Verhoeff-van Gieson

Weigert

Question 16

Elastic tissue stains reveal a selective band-like loss of elastic fibers in the middermis

Answer 16

Middermal elastolysis

Question 17

Onset in an older age group, location in only sun-exposed areas, yellowish color, and coarser wrinkling
Hyperplasia and abnormalities of elastic fibers and basophilic degeneration of the collagen in the papillary dermis

Answer 17

Solar elastosis

Question 18

Selective and almost complete loss of elastic fibers surrounding the follicles
Elastase-producing Staphylococcus epidermidis was found in the hair follicles and is the presumed etiology of this condition

Answer 18

Perifollicular elastolysis

Question 19

Originally described in young girls of African descent
Indurated plaques or urticaria, malaise, and fever, preceded the diffuse wrinkling, atrophy, and severe disfigurement
Insect bites may be the trigger for initial inflammatory lesions

Answer 19

Postinflammatory elastolysis and cutis laxa

Question 20

Striae commonly develop during

Answer 20

Puberty

Pregnancy

Question 21

Multiple, symmetric, well-defined, linear atrophic lesions that follow the lines of cleavage

Answer 21

Striae

Question 22

Histologic findings show a decrease in dermal thickness and in collagen in the upper dermis
Dermal elastin can be fragmented

Answer 22

Striae

Question 23

Characterized by rows of yellow palpable striae-like bands on the lower back
Elderly men are most commonly affected
Focal increase in the number of elongated or fragmented elastic fibers and thickened dermis

Answer 23

Linear focal elastolysis (elastotic striae)

Question 24

Topical treatments that have shown some improvement of early stage striae

Answer 24

Tretinoin 0.1% cream
Tretinoin 0.05%/glycolic acid 20%
L-ascorbic 10%/glycolic 20%

Question 25

Form of dermal atrophy that presents as 1 or several sharply demarcated depressed patches with no outpouching, usually on the back of adolescents or young adults Clinical and histologic similarities to the atrophy seen at sites of regressing plaques of morphea

Answer 25

Idiopathic atrophoderma of Pasini and Pierini

Question 26

Antibodies to _____ have been reported in idiopathic atrophoderma of Pasini and Pierini

Answer 26

Borrelia burgdorferi

Question 27

The borders or edges of lesions of idiopathic atrophoderma of Pasini and Pierini are sharply defined, and they are usually described as abrupt, “_____” borders

Answer 27

Cliff-drop

Question 28

Usually present as indurated, often hyperpigmented plaques with a characteristic peripheral lilac rim

Answer 28

Morphea

Question 29

Dimple-like depressions at the follicular orifices | Can be seen most commonly on the cheeks and on the backs of the hands or feet

Answer 29

Follicular atrophoderma

Question 30

Multiple inflammatory symmetric papules on the cheeks, presumably centered around hair follicles, may precede the atrophic lesions Found exclusively on the cheeks

Answer 30

Atrophoderma vermiculatum

Question 31

Can include atrophoderma vermiculatum but also a group of closely related disorders that includes keratosis follicularis spinulosa decalvans and ulerythema ophryogenes

Answer 31

Keratosis pilaris atrophicans

Question 32

Characterized by keratotic follicular papules, variable degrees of inflammation, and secondary atrophic scarring

Answer 32

Keratosis pilaris atrophicans

Question 33

Begins in infancy with keratotic follicular papules over the malar area and progresses to involve the eyebrows, scalp, and extremities, with scarring alopecia

Answer 33

Keratosis follicularis spinulosa decalvans

Question 34

Affecting primarily the lateral portion of the eyebrows with erythema, follicular papules, and alopecia

Answer 34

Ulerythema ophryogenes

Question 35

Also known as keratosis pilaris atrophicans faciei

Answer 35

Ulerythema ophryogenes

Question 36

``` Milia Telangiectasias BCCs Hypotrichosis Acral cyanosis Trichoepitheliomas ```

Answer 36

Rombo syndrome

Question 37

Syringomas | Milia

Answer 37

Nicolau-Balus syndrome

Question 38

Scrotal tongue

Answer 38

Tuzun syndrome

Question 39

Palmoplantar hyperkeratosis | Keratosis pilaris

Answer 39

Braun-Falco-Marghescu syndrome

Question 40

``` Follicular atrophoderma Milia Multiple BCCs Hypotrichosis Localized hypohidrosis ```

Answer 40

Bazex-Dupre-Christop syndrome

Question 41

Icthyosiform scaling erythroderma patterned along the lines of Blaschko that usually resolves during the first year of life and is replaced by bands of follicular atrophoderma X-linked dominant disorder that occurs only in girls because it is usually ketgal in hemizygous males

Answer 41

Conradi-Hunermann-Happle syndrome

Question 42

Ichthyosis with keratotic follicular plugs containing dystrophic calcification in newborns are distinctive histopathologic features

Answer 42

Conradi-Hunermann-Happle syndrome