A teenage girl with atopic dermatitis who developed multiple, asymptomatic, skin-colored papules on the chest and abdomen was diagnosed with secondary anetoderma following molluscum contagiosum.
The lesions appeared 2 months earlier and were described as nonfollicular papules with a characteristic “waterdrop” or “rose-petal” morphology. Clinical photographs from the initial eruption were compatible with molluscum contagiosum (MC), and neither the pediatrician nor dermatologist had been consulted at that time.
Histopathology revealed fibrosis and vascular proliferation in the papillary dermis. Verhoeff–Van Gieson staining showed absence of elastic fibers in the papillary dermis with preservation elsewhere, and no remnants of MC were identified.
“Results of Verhoeff-Van Gieson staining demonstrated an absence of elastic fibers in the papillary dermis, whereas they were preserved in the remainder of the sample,” noted Daniel Ramos-Rodríguez, MD, of the Dermatology Department at University Hospital Canary Islands and the University of La Laguna, Santa Cruz de Tenerife, Spain, and colleagues.
On dermoscopy, white circles with a central brown, structureless area were observed. No atypical vessels were present. Lesions showed no improvement after 2 years of follow-up; cosmetic laser therapy was recommended.
Anetoderma is a benign elastolytic disorder characterized by focal loss of dermal elastic tissue. Primary anetoderma arises in previously normal skin, while secondary anetoderma develops at sites of prior inflammation or infection. Reported subtypes include primary (often autoimmune-associated), secondary, drug-induced, familial, and prematurity-associated.
Secondary anetoderma after molluscum contagiosum is uncommon. Proposed mechanisms involve complement-mediated macrophage recruitment and elastase-driven degradation of elastic fibers.
Diagnosis rests on clinicopathologic correlation with evidence of selective elastic fiber loss. Key differentials include lichen nitidus (well-circumscribed lymphohistiocytic infiltrate without elastic fiber loss), miliaria crystallina (eccrine duct obstruction with superficial vesicles), and mpox infection (ballooning degeneration of keratinocytes with mixed inflammatory infiltrates). Management remains supportive; established lesions generally persist, and cosmetic options such as laser may be considered.
Full disclosures can be found in the case.
Source: JAMA Dermatology
