70 - Anetoderma and Other Atrophic Disorders of the Skin Flashcards
The lesions in anetoderma usually occur in _____ and more often in _____
Young adults between the ages of 15 and 30 years
Women than men
Anetoderma can be associated with various systemic conditions, primarily
Antiphospholipid antibodies
Characteristic lesions are flaccid circumscribed area of slack skin with the impression of loss of dermal substance forming depressions, wrinkling, or sac-like protrusions
Anetoderma
Examining finger sinks without resistance into a distinct pit with sharp borders as if into a hernia ring
Buttonhole sign
Most common sites for anetoderma
Chest
Back
Neck
Upper extremities
Types of anetoderma
Primary - no underlying associated skin disease
Secondary - atrophic lesions has appeared in the exact same site as a previous specific pathology
Types of primary anetoderma
- Those with preceding inflammatory lesions, mainly erythema (Jadassohn-Pellizzari type)
- Those without preceding inflammatory lesions (Schweninger-Buzzi type)
Most common causes of secondary anetoderma
Acne
Varicella
Both primary and secondary types of anetoderma may be associated with an underlying disease, mainly
Antiphospholipid syndrome
Autoimmune thyroiditis
HIV
Predominant defect in anetoderma
Focal partial or complete loss of elastic tissue in the papillary and/or midreticular dermis
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
Papular elastorrhexis
Papular elastorrhexis is differentiated from anetoderma by being
Firm, noncompressible lesions
Characterized by patches and plaques of diffuse, fine, wrinkled skin, most often on the trunk, neck and arms
Middermal elastolysis
Types of middermal elastolysis
- Asymptomatic, well-demarcated, or diffuse areas of fine wrinkling (Type I)
- Discrete perifollicular papules (Type II)
- Reticular pattern (Type III)
Elastic tissue stains
Verhoeff-van Gieson
Weigert
Elastic tissue stains reveal a selective band-like loss of elastic fibers in the middermis
Middermal elastolysis
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
Solar elastosis
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
Perifollicular elastolysis
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
Postinflammatory elastolysis and cutis laxa
Striae commonly develop during
Puberty
Pregnancy
Multiple, symmetric, well-defined, linear atrophic lesions that follow the lines of cleavage
Striae
Histologic findings show a decrease in dermal thickness and in collagen in the upper dermis
Dermal elastin can be fragmented
Striae
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
Linear focal elastolysis (elastotic striae)
Topical treatments that have shown some improvement of early stage striae
Tretinoin 0.1% cream
Tretinoin 0.05%/glycolic acid 20%
L-ascorbic 10%/glycolic 20%
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
Idiopathic atrophoderma of Pasini and Pierini
Antibodies to _____ have been reported in idiopathic atrophoderma of Pasini and Pierini
Borrelia burgdorferi
The borders or edges of lesions of idiopathic atrophoderma of Pasini and Pierini are sharply defined, and they are usually described as abrupt, “_____” borders
Cliff-drop
Usually present as indurated, often hyperpigmented plaques with a characteristic peripheral lilac rim
Morphea
Dimple-like depressions at the follicular orifices
Can be seen most commonly on the cheeks and on the backs of the hands or feet
Follicular atrophoderma
Multiple inflammatory symmetric papules on the cheeks, presumably centered around hair follicles, may precede the atrophic lesions
Found exclusively on the cheeks
Atrophoderma vermiculatum
Can include atrophoderma vermiculatum but also a group of closely related disorders that includes keratosis follicularis spinulosa decalvans and ulerythema ophryogenes
Keratosis pilaris atrophicans
Characterized by keratotic follicular papules, variable degrees of inflammation, and secondary atrophic scarring
Keratosis pilaris atrophicans
Begins in infancy with keratotic follicular papules over the malar area and progresses to involve the eyebrows, scalp, and extremities, with scarring alopecia
Keratosis follicularis spinulosa decalvans
Affecting primarily the lateral portion of the eyebrows with erythema, follicular papules, and alopecia
Ulerythema ophryogenes
Also known as keratosis pilaris atrophicans faciei
Ulerythema ophryogenes
Milia Telangiectasias BCCs Hypotrichosis Acral cyanosis Trichoepitheliomas
Rombo syndrome
Syringomas
Milia
Nicolau-Balus syndrome
Scrotal tongue
Tuzun syndrome
Palmoplantar hyperkeratosis
Keratosis pilaris
Braun-Falco-Marghescu syndrome
Follicular atrophoderma Milia Multiple BCCs Hypotrichosis Localized hypohidrosis
Bazex-Dupre-Christop syndrome
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
Conradi-Hunermann-Happle syndrome
Ichthyosis with keratotic follicular plugs containing dystrophic calcification in newborns are distinctive histopathologic features
Conradi-Hunermann-Happle syndrome
