Atrophoderma of Pasini and Pierini. An immunopathologic case study

Idiopathic Atrophoderma of Pasini and Pierini

Background:

Idiopathic atrophoderma of Pasini and Pierini (LAPP) is a rare pattern of dermal atrophy, with less than 300 cases reported worldwide. Currently, there is controversy surrounding the classification of LAPP; some consider it to be a variant of morphea, while others view it as a separate disease entity.

Objective:

Our purpose was to further elucidate the nature and course of this unusual disease.

Methods:

We present a case report, with long-term follow-up of a case of IAPP of 30 years' duration.

Results:

The patient's lesions were primarily atrophic, without progression to morphea, scleroderma, or other systemic disease. Biopsy of a long-standing plaque demonstrated dermal thinning, and minimal dermal infiltrate.

Conclusion:

This case supports the findings of the literature on this subject: the majority of patients with IAPP have an entirely benign course, without progression to other disease.

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."

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.

Atrophoderma elastolytica discreta

Atrophoderma elastolytica discreta is the clinicopathologic name for a unique entity herein first described in a patient with cutaneous lesions simulating atrophoderma of Pasini and Pierini but coupled with histopathologic changes of anetoderma. The clinical and histological findings seen here have not been previously seen in the many variants of anetoderma, and, as such, they are sui generis evidence of a new entity in clinical dermatology.

Zosteriform atrophoderma of Pasini and Pierini

Astophoderma of Pasini and Pierini is generally regarded as an atrophic variant of morphoea. It arises most commonly on the trunk and abdomen. We describe a 53-year-old man who had a 12-year history of unilateral atrophoderma of Pasini and Pierini affecting the left side of his trunk in a zosteriform distribution. Within these clinically atrophic lesions, there were localized areas of induration which were typical of morphoea. The patient also had a preceding history of balanitis xerotica obliterans. The occurrence of atrophoderma of Pasini and Pierini, morphoea and lichen sclerosus within the same individual supports the view that these conditions are closely related, and suggests that common factors may be involved in their aetiologies.

Atrophoderma of Pasini and Pierini. Clinical and histopathologic findings and antibodies to Borrelia burgdorferi in thirty-four patients

BACKGROUND

Idiopathic atrophoderma of Pasini and Pierini (IAPP) is a distinctive form of dermal atrophy, usually appearing as one or more sharply demarcated depressed areas. Little is known about the clinical variants of IAPP, and limited data are available on antibiotic therapy for this condition.

OBJECTIVE

Our purpose was to define the various types of IAPP clinically and histologically and to investigate a possible association with Borrelia burgdorferi infection.

METHODS

The records of 34 patients with IAPP were reviewed. Skin biopsy specimens for routine histologic examination were obtained from 17 patients. Serum from 26 patients was analyzed for antibodies against B. burgdorferi.

RESULTS

Of the 34 patients (21 female, 13 male, 7 to 66 years of age), 23 had well-circumscribed brown, depressed plaques. The back was most frequently involved (82%). Eleven patients had a superficial variant of IAPP, characterized by slightly atrophic brown macules forming large hyperpigmented patches with an irregular border. Secondary areas of induration developed in 7 of 34 patients. Ten of 26 patients (38%) had elevated serum antibodies to B. burgdorferi. Twenty of the 25 patients treated with oral antibiotics had clinical improvement with no evidence of new active lesions.

CONCLUSION

IAPP is an abortive, primarily atrophic variant of morphea. The clinical appearance of IAPP may be variable according to the stage of dermal atrophy and distribution of the lesions.