Atrophoderma of Pasini and Pierini Differential Diagnoses

  • Author: Sarah Jane Adams, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 11, 2016
 
 

Diagnostic Considerations

Late-stage morphea, systematized epidermal nevus, postinflammatory hyperpigmentation secondary to herpes zoster, and linear atrophoderma of Moulin may resemble idiopathic atrophoderma of Pasini and Pierini. Many consider idiopathic atrophoderma of Pasini and Pierini to be an atrophic stage of morphea.

Since the original description, much debate has occurred regarding whether idiopathic atrophoderma of Pasini and Pierini is a distinct entity or an atrophic, nonindurated variant of morphea, despite differences in the origin, development, and outcome of the lesions. The existence of a relationship between idiopathic atrophoderma of Pasini and Pierini and morphea is supported by the striking clinical and histological similarities seen at sites of regressing plaques of morphea. Morphea characteristically begins as a discrete circumscribed, erythematous-to-sclerotic plaque, often with a white center and characteristic peripheral lilac rim. Idiopathic atrophoderma of Pasini and Pierini lacks sclerosis, and lesions commonly coalesce over time. There may be a moth-eaten appearance that is not consistent with morphea.

From a distance, the skin depression in lichen sclerosis et atrophicus, anetoderma, or resolving panniculitis may resemble a stage of idiopathic atrophoderma of Pasini and Pierini, but these conditions lack the pigmentation seen in persons with idiopathic atrophoderma of Pasini and Pierini. Anetoderma, also a dermal atrophic process, is easily differentiated by palpation and, with histology studies, loss of dermal elastic fibers.

Typical lesions of morphea and idiopathic atrophoderma of Pasini and Pierini may appear in different or adjacent areas on the same individual. These conditions may occur simultaneously or one may precede the other. This observation may support the hypothesis that idiopathic atrophoderma of Pasini and Pierini and morphea are variations in response to the same abnormality.

The diagnosis of linear atrophoderma of Moulin requires that the acquired hyperpigmented linear atrophoderma follows Blaschko lines. However, a 2016 paper suggests that this entity may simply represent a linear variant of atrophoderma of Pasini and Pierini.[13]

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Sarah Jane Adams, MD Resident Physician, Department of Dermatology, Northwestern University, The Feinberg School of Medicine

Sarah Jane Adams, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Womens Association, Chicago Dermatological Society, Society for Melanoma Research

Disclosure: Nothing to disclose.

Coauthor(s)

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD Professor of Dermatology, Chief of General Dermatology, Director of the Collagen Vascular Disorders Clinic, Northwestern University, The Feinberg School of Medicine

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, British Association of Dermatologists, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Illinois State Medical Society, Medical Dermatology Society, Society for Investigative Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Pranathi Lingam, MD Resident Physician, Department of Dermatology, University of Michigan Medical School

Disclosure: Nothing to disclose.

Acknowledgements

Peter Fritsch, MD Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria

Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard H Musgnug, MD Former Assistant Clinical Professor, Department of Dermatology, Thomas Jefferson Medical School, Virtua Memorial Hospital, Cooper Medical Center

Disclosure: Nothing to disclose.

Neelam Vashi, MD Resident Physician, Department of Dermatology, New York University Medical Center

Neelam Vashi, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Physicians of Indian Origin, American Medical Association, and Indian American Medical Association

Disclosure: Nothing to disclose.

References
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Early lesion demonstrating diagnostic "cliff-drop" border to atrophy. Courtesy of Joe Eastern, MD.
Older lesion showing typical pigmentation and classic "cliff-drop" border. Courtesy of Joe Eastern, MD.
Single ovoid patch of atrophoderma on the back of a young adult female.
Atrophic hyperpigmented patch with characteristic “cliff-drop” borders.
 
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