Atrophic dermatosis on bilateral legs

Presenter: Jennifer Peterson DO, Angelo Petropolis MD, Amy Weierman PA-C
Dermatology Program: Advanced Desert Dermatology
Program Director: Vernon T Mackey DO
Submitted on: Aug 30, 2015

CHIEF COMPLAINT:  A 65 year-old Caucasian female presented for evaluation of odd blotchiness on her legs.

CLINICAL HISTORY:

Signs and symptoms:  The patient reported onset of blotchiness on her legs approximately 1 month prior to presentation. She denied any local or constitutional symptoms associated with skin lesions. No history of recent travel or medication changes.

Her past medical history is significant for hypothyroidism (controlled on levothyroxine), chronic arthritis, morbid obesity status-post gastric bypass surgery (with subsequent profound weight loss), and anemia secondary to malabsorption.

Previous Treatment:  None

Other information:  A 10-point review of systems was performed, and did not reveal any new, evolving, or unexplained signs or symptoms.

PHYSICAL EXAM:

Physical examination revealed multiple focal pink to purple macules and flaccid papules with a thin, wrinkled surface, clustered in a regular reticular pattern on the bilateral anterior and medial thighs and lower legs. Lesions exhibited a positive buttonhole sign on compression.

LABORATORY TESTS:

Done following biopsy; see Treatment section below.

DERMATOHISTOPATHOLOGY:

Two 4 mm punch biopsies were obtained from lesions on the right thigh. Sections showed an unremarkable epidermis and dermis, however an elastic tissue stain demonstrated mild diminution of elastic fibers in one of the specimens.

 

H&E (left), Verhoeff-van Gieson stain (right) shows diminished elastic fibers in the papillary dermis. [image from Dermatology Online Journal]

DIFFERENTIAL DIAGNOSIS:

1.   Generalized granuloma annulare
2.   Granulomatous slack skin
3.   Papular elastorrhexis
4.   Anetoderma
5.   Atrophoderma of Pasini and Pierini


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