What is Anetoderma ?

 Anetoderma : 

Anetoderma is an uncommon condition in which the elastic tissue in the dermis is lost, resulting in a depression in the skin . It is also known as macular atrophy . Anetoderma more commonly affects women than men ,  and the lesions may develop where adhesives such as  monitoring leads had been attached . 

Anetoderma seems to be most commonly reported in central  Europe . There have been rare cases of anetoderma affecting family members  including  monozygotic  twins . There are 2 formd  of anetoderma - primary and secondary , the cause of the primary form is not known . secondary anetoderma occurs at the sites of other unrelated skin conditions which include :

Infections - chickenpox , syphilis 

Tumours - pilomatrixoma  , plasmacytoma , schwannoma , cutaneous B cell  lymphoma , juvenile xanthogranuloma 

Infantile haemangioma 

Inflammatory skin conditions - acne  , granuloma annulare , lupus profundus .

There appears to be a particular  associated with the presence of anti phospholipid  antibodies , often  features  required to diagnosed anti phospholipid syndrome . The old classification of Schweninger - Buzzi and Jadassohn Pellizari types , non inflammatory  versus inflammatory , is  no longer  considered useful as both types  of lesion  can be seen  in the one patients and many  clinically non- inflammatory  lesion show inflammaderma tory lesions  show inflammation on histology . This  classification does not predict  prognosis and is therefore no longer used . 

Anetoderma is a localized laxity of the skin with herniation or  outpouching resulting  from abnormal dermal elastic tissue . 

Treatments of Anetoderma :

There is no sucessful treatment to reverse the already formed  lesions of anetoderma . single lesions may be excised. An underlying condition has been diagnosed , sucessful treatment can prevent the formation of further lesions . The typical clinical of anetoderma is of multiple round well defined 1-2 cm lesions with wrinkly skin overlying a palpable depression, the so called button  hole sign .  Lesions may be flat , raised or depressed , skin colored or bluish- white . Anetoderma lesions are most commonly found on the chest, back , neck  and arms , but any site can be affected . they are not related to hair follicles . 

Based  on whether an inflammatory reaction occurred before the appearance  of the atrophy , two types of primary  macular  anetoderma have been  described  anetoderma  oval and slightly  depressed .  as the redness disappears . 

Healthy skin is one that stays taut and firm . Anetoderma is a rare  benign condition where the dermis loses elastic tissue . This results in the formation  of a depression in the skin or flaccid skin . This condition is also known as macular atrophy , anetoderma maculosa , atrophia maculosa cutis . Anetoderm is not contagious . 

women are at a higher risk of suffering  from this condition that men . It usually affect  people in their late teens ans early 20s . Premature babies  born with a very low birth  weight  are also  susceptible to this  conditon . in rare cases , it can run in the family  and affect identical twins . Depending  on it is triggered , there are 2 types of Aneto derma , primary and secondary . Both forms of this condition may be associated  with systemic  disease that include infections like leprosy , HIV and lyme disease  inflammatory  or autoimmune  conditions and medications like penicillamine . 

PRIMARY ANETODERMA :

This is marked by the spontaneous eruptions of lesion on the skin without any other  symptoms . the cause for primary anetoderma has not yet been   determined. The suggest causes include  antiphospholipid antibodies immunological abnormalities and reduced production of elastin . It has also been associated with cataract bone calcification , myocardial infraction and blegvadhaxthausen syndrome . 

SECONDARY ANETODERMA :

In this case, atrophic lesions are preceded by inflammatory or autoimmune processes. This usually occurs at the site of skin condition  such as chicken pox , syphilis , tumours , acne , infantile  haemangioma etc .  Both types of anetoderma can occuer simultaneously . The main symptoms of primary and secondary anetoderma are :

small round or oval lesion on the upper arms , upper  body and thighs . these lesions rarely occur on the neck , face , palms , and soles . 

Pictures of Anetoderma :

The skin is made up of three layers, which consists of an outermost layer or epidermis , a middle layer known as the dermis and a bottom layer called the subcutaneous fat . each layer has grity of the skin . Anetoderma is a benign or harmless skin conditions specific functions and contributes in some ways to the overall strength and integrity  of the skin . Anetoderma is a benign or harmless skin condition , in which  the dermis loses its normal architecture . The affected skin takes on a differences appearance, often  resulting in depressions in the skin or out punching in the area of cocern . often the patients will notice  adepressions in the skin with the overlying  area of loose skin . 

Anetoderma is classified by dermatologists as being  primary or secondary . primary anetoderma is an idiopathic condition  , while secondary  anetoderma can be caused by certain  systemic diseases, which can include various  autoimmune diseases  and infections . 

Management of Anetoderma  :

There have been various medical tratments for anetoderma reported , but none have been effective  in established  lesions . Colchicine has been shown to prevnt new primary anetoderma lesions from  forming . In secondary  anetoderma , controlling the causative dermatoses should theoretically prevent new lesions from forming . 

Other treatments that have been used with no studied include  cryotherapy, intralesional steroids , colchicine , vitamin E , oral penicillin G , niacin , dapsone , and phenytoin . Established lesions can be excised for definitive treatment but will leave a permanent scar . Laser  treatment may improve lesion appearances according to limited case reports . 

Diagnosis of Anetoderma :

Disease commonly mistaken for anetoderma consist primarily  of disorder of elastic  tissue leading to cutaneous atrophy  similar to that of anetoderma . Mid dermal elastolysis has a loss of mid - dermal  elastic  fibers  that cause the skin to have a widespread loose sagging  appearance .  A trophoderm of Pasini and pierini present as brown , gray or violaceous macules or patches with a distinct  drop off  sloping bordet on palpation most commonly located on the trunk .