Atrophoderma vermiculatum: Histological findings of the early and late lesions. Study of a case

Atrophoderma Vermiculatum (AV) is a rare disease characterized by the occurrence on the face and the cheeks in particular, of fine, atrophic pits, with a bilateral distribution, producing a honeycomb, reticulate appearance. All the cases reported in the literature focus on the atrophic changes of the disease while no attention has been paid to the condition which causes atrophy. The early stages are not usually reported. MC is a girl aged 13. She had multiple, fine, pale-brown papules (1-2 mm in diameter) on her right cheek. The histopathological findings of these lesions predominantly showed lymphocytic perifolliculitis with perifollicular fibrosis. The epidermis was normal. No specific diagnosis other than perifolliculitis was possible. Eight months later the patient showed tiny, atrophic depressions and follicular plugs with reticulate teleangectases in the same area of the right cheek (with disappearance of the tiny papules). A clinical diagnosis of AV was done. The histological findings of a further biopsy showed atrophy of the epidermis, less severe perifollicular inflammation and decrease in number of the follicles. The hair follicles were widely dilated and were either empty or contained keratinous materials. Dermal atrophy and disappearance of elastic fibers was noticeable. In conclusion the late clinical features of the lesions, through unusual (asymmetry of the lesion, small and superficial atrophic scars), make the diagnosis of the early clinical and histological features of papules and perifolliculitis possible and suggest a specific name: Early stages of AV.