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A case of primary anetoderma in an infant

SIR, Anetoderma is a rare cutaneous disorder characterized by a localized depression or outpouching of the skin caused by laxity and weakening of the dermal connective tissue as a result of focal loss of elastic fibres. It is sometimes not associated with any underlying disease [primary (idiopathic) anetoderma] or it can be related to many kinds of dermatoses (secondary anetoderma). In the past, cases of primary anetoderma were classified into the Jadassohn–Pelizzari type, following erythema or urticaria, and the Schweninger–Buzzi type with no preceding inflammatory skin lesions. Currently, this classification is becoming less important because, whether or not one can recognize this feature, it is only an individual variable, not a disease-defining feature. Anetoderma occurs mainly in middle-aged women, often in children and rarely in infants. We report an interesting case of primary anetoderma, the Schweninger–Buzzi type, which occurred in a 1-month-old infant. To our knowledge, this is the youngest reported age of onset of a case that is not congenital. A 5-month-old boy presented with increasing numbers of multiple atrophic and sac-like whitish papules on his trunk and both extremities, which started to develop only 1 month after birth (Fig. 1a,b). He had no history of preceding inflammatory skin diseases and did not show any symptom associated with the development of the skin lesions. He was born after a full-term single pregnancy and had no problems during the perinatal period. The family history was not contributory. On clinical examination, the otherwise healthy-looking boy presented with 40–50 atrophic and sac-like round to ovalshaped whitish papules on the trunk, buttocks and both extremities. The lesions were 2–20 mm in diameter and were well circumscribed, presenting either as a depression below the level of normal skin or as a sac-like protrusion. Routine laboratory examinations were within normal limits. There were no neurological, orthopaedic or ophthalmological abnormalities. A biopsy was performed from a typical looking lesion on his back. Histopathological examination revealed a mild perivascular infiltrate with lymphocytes in the mid-dermis (Fig. 2a). The elastic stain demonstrated a decreased number of elastic fibres in the superficial and the mid-dermis (Fig. 2b). A 12-month period of treatment with clobetasone butyrate (0Æ5 mg g) cream showed no effective response and, during that time, we noticed about 10–15 newly developed skin lesions. We are still observing the patient every 2–3 months. Anetoderma, which was first described by Jadassohn in 1892, is characterized clinically by small, atrophic papules with flaccid skin, inward herniation at palpation and histopathological loss of elastic tissue. This rare disorder occurs