Multiple depressed plaques over back in a young boy.

Abstract

A 12-year-old boy presented with a 6-month history of asymptomatic but gradually progressive depressed lesions over the back. There was no history of any preceding local trauma, infection, ulceration, or any inflammatory dermatoses. He was not on any medications and his family members had no history of similar skin lesions. On examination, multiple discrete, sharply demarcated, hyperpigmented, smooth-surfaced, nonindurated, noninflammatory atrophic plaques of varying diameters (2 cm to 7 cm) were noticed dispersed over the back; an abrupt border transitioning into normal skin gave it the typical ‘cliff drop’ appearance (Figure 1). Other mucocutaneous and systemic examination was unremarkable. Routine laboratory investigation was noncontributory and serum antibody for Borrelia burgdorferi was negative. Histopathological examination revealed normal epidermis, hyalinization of collagen in dermis with minimal scattered inflammatory infiltrate, and decrease in the thickness of dermis compared to surrounding skin. What is the diagnosis? ... Based on distinctive clinical and corroborative histopathological features, a diagnosis of idiopathic atrophoderma of Pasini and Pierini (IAPP) was established. He was counselled about the benign nature of the condition; topical tacrolimus (0.1%) ointment was started twice daily with subsequent partial improvement of lesions in 3 months.