Journal of Dermatology 2014; 40: 1–2
doi: 10.1111/1346-8138.12361
LETTER TO THE EDITOR
Unusual case of linear anetoderma in children Dear Editor, Anetoderma is a benign condition with focal loss of dermal elastic tissue resulting in localized areas of flaccid or herniated sac-like skin. Currently, anetoderma is classified as either primary (idiopathic) or secondary (which is associated with a variety of skin conditions, penicillamine use or neonatal prematurity).1 Herein, we report an unusual case of linear anetoderma in a young boy. A 10-year-old boy presented to our observation for a 7-year history of atrophic linear striae located in his lower abdomen (not along Blaschko’s lines), not associated with itching or pain. He had a past history of asthma, hay fever, dandruff and atopic eczema. Examination showed several linear atrophic striae of his lower abdomen measuring a maximum of 60 mm in length (Fig. 1a). Histology revealed that the epidermal layer was characterized by a diffuse hyperpigmentation of the basal layer. A mild perivascular infiltrate composed by mononuclear inflammatory cells was present in the superficial and reticular dermis. A diffuse dermal sclerosis was noted (Fig. 1b). A very mild chronic inflammation was present around adnexal structures (Fig. 1c). Van Gieson’s stain showed a paucity of elastin fibers within the papillary dermis, in both superficial and mid-dermis. Laboratory examinations consisting of complete blood count, urinalysis and blood chemistry including erythrocyte sedimentation rate and liver function tests were within normal limits. Antinuclear antibody was negative. The patient had no risk factor for AIDS or syphilis, so we did not request HIV or Venereal Disease Research Laboratory test. Hepatitis B sur-
(a)
(b)
face antigens were not detected. Immunological assays consisting of immunoglobulin M, IgA, IgG, IgE, C3 and C4 levels were normal. Anetoderma (anetos = slack) is a rare benign dermatosis, first described by Jadassonh in 1892, caused by a loss of middermal elastic tissue resulting in well-circumscribed areas of pouch-like herniations of flaccid skin. It is classically categorized as either primary (idiopathic) or secondary (following an inflammatory dermatosis in the same location).1 Our patient, who is an atopic subject, exhibited long linear atrophic lesions with histological aspect of linear anetoderma, probably following an inflammatory dermatosis located in his lower abdomen, such as a lichen striatus which is frequently described in atopic patients. A differential diagnosis is the linear atrophoderma of Moulin, which is a rare, acquired, linear dermatosis described by Moulin in 1992, appearing as pigmented and more or less atrophic bands along Blaschko’s lines. Histologically, it is characterized by irregular and moderate hyperpigmentation of the basal layer, and no alterations of dermis (or inflammation or alterations of connective tissue texture). In fact, the skin atrophy is related to atrophy of the subcutaneous tissue. These clinical and pathological features differentiate it from linear anetoderma.2 Only one other case of linear anetoderma has been reported in the published work in a 16-year-old girl reporting anetoderma in the site of a chronic angular cheilitis.3 We report this case for its rare clinical presentations and to encourage clinicians to consider it in the possible differential diagnosis of linear atrophic lesions in young patients.
(c)
Figure 1. (a) Linear anetoderma. (b) Hematoxylin–eosin stain (original magnification 9100). Epidermal layer is characterized by a diffuse hyperpigmentation of the basal layer. A mild perivascular infiltrate composed by mononuclear inflammatory cells is present in the superficial and reticular dermis. A diffuse dermal sclerosis is noted. (c) A very mild chronic inflammation is present around adnexal structures (hematoxylin–eosin, 9100).
Correspondence: Antonella Tammaro, M.D., UOC Dermatology, NESMOS Department, Sant’Andrea hospital, University of Rome Sapienza, Via di Grottarossa, Rome 1035, Italy. Email: [email protected]
© 2014 Japanese Dermatological Association
1
Letter to the Editor
CONFLICT OF INTEREST:
None.
Antonella TAMMARO,1 Alessandra NARCISI,1 Claudia ABRUZZESE,1 Giorgia CORTESI,1 Veronica GIULIANELLI,3 Francesca R. PARISELLA,4 Fabio SOCCIARELLI,2 Gabriella De MARCO,1 Severino PERSECHINO1 1 UOC Dermatology, NESMOS Department, Sant’Andrea Hospital, University of Rome Sapienza, 2UOC Histopathology, Sant’Andrea Hospital, University of Rome Sapienza, 3Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome Sapienza, Rome, Italy, and 4 Faculty of Medicine, University of Towson, Towson City, Maryland, USA
2
REFERENCES 1 Shahin A, Manouchehr S, Fatemeh SA, Nazila M. An unusual presentation of anetoderma: a case report. BMC Dermatology 2004; 4: 9–15. 2 Aikaterini P, Aikaterini K, Chaidemenos G, Sotiriadis D. Linear atrophoderma of Moulin: a case report and review of the literature. Dermatol Pract Concept 2013; 3: 7–11. 3 Crone AM, James MP. Acquired linear anetoderma following angular cheilitis. Br J Dermatol 1998; 138: 923–924.
© 2014 Japanese Dermatological Association
doi: 10.1111/1346-8138.12361
LETTER TO THE EDITOR
Unusual case of linear anetoderma in children Dear Editor, Anetoderma is a benign condition with focal loss of dermal elastic tissue resulting in localized areas of flaccid or herniated sac-like skin. Currently, anetoderma is classified as either primary (idiopathic) or secondary (which is associated with a variety of skin conditions, penicillamine use or neonatal prematurity).1 Herein, we report an unusual case of linear anetoderma in a young boy. A 10-year-old boy presented to our observation for a 7-year history of atrophic linear striae located in his lower abdomen (not along Blaschko’s lines), not associated with itching or pain. He had a past history of asthma, hay fever, dandruff and atopic eczema. Examination showed several linear atrophic striae of his lower abdomen measuring a maximum of 60 mm in length (Fig. 1a). Histology revealed that the epidermal layer was characterized by a diffuse hyperpigmentation of the basal layer. A mild perivascular infiltrate composed by mononuclear inflammatory cells was present in the superficial and reticular dermis. A diffuse dermal sclerosis was noted (Fig. 1b). A very mild chronic inflammation was present around adnexal structures (Fig. 1c). Van Gieson’s stain showed a paucity of elastin fibers within the papillary dermis, in both superficial and mid-dermis. Laboratory examinations consisting of complete blood count, urinalysis and blood chemistry including erythrocyte sedimentation rate and liver function tests were within normal limits. Antinuclear antibody was negative. The patient had no risk factor for AIDS or syphilis, so we did not request HIV or Venereal Disease Research Laboratory test. Hepatitis B sur-
(a)
(b)
face antigens were not detected. Immunological assays consisting of immunoglobulin M, IgA, IgG, IgE, C3 and C4 levels were normal. Anetoderma (anetos = slack) is a rare benign dermatosis, first described by Jadassonh in 1892, caused by a loss of middermal elastic tissue resulting in well-circumscribed areas of pouch-like herniations of flaccid skin. It is classically categorized as either primary (idiopathic) or secondary (following an inflammatory dermatosis in the same location).1 Our patient, who is an atopic subject, exhibited long linear atrophic lesions with histological aspect of linear anetoderma, probably following an inflammatory dermatosis located in his lower abdomen, such as a lichen striatus which is frequently described in atopic patients. A differential diagnosis is the linear atrophoderma of Moulin, which is a rare, acquired, linear dermatosis described by Moulin in 1992, appearing as pigmented and more or less atrophic bands along Blaschko’s lines. Histologically, it is characterized by irregular and moderate hyperpigmentation of the basal layer, and no alterations of dermis (or inflammation or alterations of connective tissue texture). In fact, the skin atrophy is related to atrophy of the subcutaneous tissue. These clinical and pathological features differentiate it from linear anetoderma.2 Only one other case of linear anetoderma has been reported in the published work in a 16-year-old girl reporting anetoderma in the site of a chronic angular cheilitis.3 We report this case for its rare clinical presentations and to encourage clinicians to consider it in the possible differential diagnosis of linear atrophic lesions in young patients.
(c)
Figure 1. (a) Linear anetoderma. (b) Hematoxylin–eosin stain (original magnification 9100). Epidermal layer is characterized by a diffuse hyperpigmentation of the basal layer. A mild perivascular infiltrate composed by mononuclear inflammatory cells is present in the superficial and reticular dermis. A diffuse dermal sclerosis is noted. (c) A very mild chronic inflammation is present around adnexal structures (hematoxylin–eosin, 9100).
Correspondence: Antonella Tammaro, M.D., UOC Dermatology, NESMOS Department, Sant’Andrea hospital, University of Rome Sapienza, Via di Grottarossa, Rome 1035, Italy. Email: [email protected]
© 2014 Japanese Dermatological Association
1
Letter to the Editor
CONFLICT OF INTEREST:
None.
Antonella TAMMARO,1 Alessandra NARCISI,1 Claudia ABRUZZESE,1 Giorgia CORTESI,1 Veronica GIULIANELLI,3 Francesca R. PARISELLA,4 Fabio SOCCIARELLI,2 Gabriella De MARCO,1 Severino PERSECHINO1 1 UOC Dermatology, NESMOS Department, Sant’Andrea Hospital, University of Rome Sapienza, 2UOC Histopathology, Sant’Andrea Hospital, University of Rome Sapienza, 3Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome Sapienza, Rome, Italy, and 4 Faculty of Medicine, University of Towson, Towson City, Maryland, USA
2
REFERENCES 1 Shahin A, Manouchehr S, Fatemeh SA, Nazila M. An unusual presentation of anetoderma: a case report. BMC Dermatology 2004; 4: 9–15. 2 Aikaterini P, Aikaterini K, Chaidemenos G, Sotiriadis D. Linear atrophoderma of Moulin: a case report and review of the literature. Dermatol Pract Concept 2013; 3: 7–11. 3 Crone AM, James MP. Acquired linear anetoderma following angular cheilitis. Br J Dermatol 1998; 138: 923–924.
© 2014 Japanese Dermatological Association
