Atrophoderma of Pasini and Pierini: a clinical and histopathological study

Idiopathic Atrophoderma of Pasini and Pierini: A Case Report and Literature Review

Atrophoderma of Pasini and Pierini (APP) is a rare cutaneous condition of unknown etiology, predominantly affecting young women. It is a dermatologic disorder characterized by hyperpigmented depressed patches of dermal atrophy. Patients usually present with single or multiple asymptomatic, violaceous, and sharply demarcated areas of depressed plaques; of note, unlike morphea, there is no surrounding erythema or induration. In this report, we discuss a case of a 43-year-old South Asian male patient who presented with an eight-month history of multiple asymptomatic, and depressed bluish-brown plaques that had appeared over his body. The clinicopathological correlation was consistent with a diagnosis of idiopathic atrophoderma of Pasini and Pierini (IAPP). We also engage in a review of the literature on IAPP.

Poikilodermatous plaque-like hemangioma: A benign vasoformative entity with reproducible histopathologic and clinical features

Poikilodermatous plaque-like hemangioma (PPLH) is a recently described benign vasoformative entity with only 16 cases reported to date. We present an additional case of a 90-year-old male who presented with a 2-year history of a relatively large, asymptomatic, atrophic plaque on his left buttock. The lesion was initially smaller and grew before stabilizing in size. The patient denied preceding trauma or injury at this site as well as the presence or history of any similar lesions elsewhere. Physical examination revealed a reniform atrophic pink plaque with peripheral hyperpigmentation and overlying cigarette paper wrinkling. Given this appearance, scar or post-inflammatory changes were favored clinically, but lack of preceding trauma raised clinical concerns for poikilodermatous mycosis fungoides. Given the location and appearance, a broad shave biopsy was performed to rule out mycosis fungoides. Histopathologic examination revealed an increased density of superficial endothelial-cell-lined vessels, telangiectasias with sludging and congestion of superficial dermal vessels and loss of elastic tissue fibers in the lesional area. These findings, in the context of the clinical history, were consistent with this newly described hemangioma. We present this case to increase awareness amongst dermatopathologists of the reproducible clinical and histopathologic findings of this new benign vasoformative entity.

Combined high-frequency and Doppler ultrasound in early diagnosis of atrophoderma of Pasini and Pierini

Atrophoderma of Pasini and Pierini is a skin disorder affecting dermal collagen and is clinically characterized by well-defined plaques of depressed skin. Histopathological changes are subtle, and in most cases, the diagnosis requires a comparative study with healthy skin from the same anatomical site. High frequency ultrasound is a useful imaging method for diagnosis of atrophic skin changes. A case is presented in which ultrasound can support the clinical and the histopathological diagnosis of atrophoderma of Pasini and Pierini.

Generalized lenticular atrophoderma of Pasini and Pierini

We present a 16-year-old boy with multiple, well-circumscribed, atrophic, light-brown patches on his neck, chest, and back. The authors believe that it represents an unusual presentation of atrophoderma of Pasini and Pierini and suggest the designation "generalized lenticular APP."

Linear atrophoderma of Moulin: a distinct entity?

Linear atrophoderma of Moulin (LAM) is a rare dermatologic disorder characterized by a hyperpigmented atrophoderma that consistently follows the lines of Blaschko. There are many clinical and histologic similarities between LAM, atrophoderma of Pasini and Pierini (APP), and morphea, and whether LAM represents part of a disease spectrum or its own distinct entity is debated. This case of a 16-year-old boy with LAM supports the hypothesis that LAM, APP, and morphea are a spectrum of disorders rather than unique entities. Although the patient's overall clinical picture supports a diagnosis of LAM with hyperpigmented, depressed lesions following the lines of Blaschko and perivascular lymphocytic infiltrate on biopsy, the bilateral presentation typical of APP, collagen entrapment of eccrine ducts typical of morphea, and changes in dermal collagen illustrate features spanning all three disorders, suggesting a relationship between these conditions that represents a spectrum of disease. Furthermore, a review of all reported cases of LAM in the literature suggests an evolving definition beyond what Moulin and colleagues originally described, including features related to those of APP and morphea.

Localized cutaneous fibrosing disorders

This article acquaints the reader with disorders of the skin that might mimic systemic sclerosis but whose pathology is localized to the skin and/or has extracutaneous manifestations that are different than systemic sclerosis. These disorders include localized scleroderma (morphea), eosinophilic fasciitis, scleredema, scleromyxedema, nephrogenic systemic fibrosis, and chronic graft-versus-host disease. Particular emphasis is placed on clinical and histopathologic features that help the clinician differentiate between these disorders. Treatment options are briefly reviewed.

Localized scleroderma associated with chronic hepatitis C

Hepatitis C virus has been associated with various skin conditions, such as porphyria cutanea tarda and lichen planus, as an example. The objective of this paper is based on the description of a case of localized morphea, which came years after the discovery of hepatitis C, as well as a discussion of possible relations between both diseases.

A Case of Atrophoderma of Pasini and Pierini Associated with Borrelia burgdorferi Infection Successfully Treated with Oral Doxycycline

Atrophoderma of Pasini and Pierini is a form of dermal atrophy that manifests as either single or multiple, sharply demarcated, hyperpigmented, non-indurated patches. These patches are marked by a slight depression of the skin, with an abrupt edge (i.e., the "cliff-drop" borders), usually located on the backs of adolescents or young adults. The pathophysiology of the disease is unknown, but some authors have suggested a role of Borrelia burgdorferi infection. A 35-year-old woman visited our department because of asymptomatic, hypopigmented, depressed patches on her chest and back lasting for three months. Laboratory evaluations were normal, except for positive serum antibodies to Borrelia burgdorferi. Histologic examination revealed a significantly decreased thickness of the dermis. The patient underwent treatment with oral doxycycline 200 mg/day for six weeks, after which the depth of depression was improved. Herein, we report a case of atrophoderma of Pasini and Pierini, associated with Borrelia burgdorferi infection, successfully treated with oral doxycycline.