Atrophoderma of Pasini and Pierini

Specialty: Skin.

• idiopathic cutaneous atrophy of Pasini and Pierini
• variant atrophic morphea

Why it occurs

• Benign and idiopathic localized thinning of the dermis characterized by a decrease in collagen thickness without obvious signs of inflammation or clinical sclerosis (considered by many authors as an abortive variant or localized final stage of morphea)
• Chronic latent infection suspected by spirochetes of the genus *Borrelia burgdorferi* in endemic geographic areas
• Local neurovascular alterations that modulate collagen synthesis by dermal fibroblasts
• Previous repeated mechanical physical trauma to the affected areas
• Local dysregulation of collagen synthesis types I and III.

Initial workup

Punch biopsy of 4 or 6 mm skin taken from the edge that demonstrates the transition between normal skin and the area of ​​atrophoderma (the key histopathological finding is the marked decrease in the thickness of the reticular dermis with normal but packed collagen fibers, without loss of adnexa or inflammatory infiltrate). Quantitative serology for *Borrelia burgdorferi* (ELISA and immunoblot).

Standard management

• Doxycycline — oral antibiotic indicated as first choice if positive serology for Borrelia burgdorferi is associated, dose of 100 mg every 12 hours for 14 to 21 days
• Hydroxychloroquine — synthetic antimalarial with immunomodulatory properties useful in cases of active progression, dose of 200 to 400 mg daily orally
• Clobetasol propionate 0.05% cream — applied only to the transient violaceous active edge if subclinical inflammation is suspected
• Systemic aggressive pharmacological therapy is not required if the lesions are stabilized and asymptomatic, opting for surveillance and photoprotection.