Atrophoderma of Pasini and Pierini in a young adult: a case report Antigona Begolli Gerqari 1 ✉ , Mybera Ferizi¹, Idriz Gerqari 2 1 Dermatovenerology Clinic, University Clinical Center, Prishtina, Kosovo. 2 Nuclear Medicine Department, University Clinical Center, Prishtina, Kosovo. ✉ Corresponding author: antigonagerqari@gmail.com 45 2019;28:45-46 doi: 10.15570/actaapa.2019.10 Introduction Atrophoderma of Pasini and Pierini is a skin disease manifested with depressed skin in areas that have a histopathology con- frmed as atrophy with hyperpigmentation. The disease was frst described by Pasini and later by Pierini and Vivoli (1). At that time the disease was linked to localized scleroderma, and in 1958 it was classifed as idiopathic atrophoderma (2). Youkoyama et al. discovered that the glycosaminoglycans found in atrophoderma of Pasini and Pierini were diferent from the ones observed in mor- phea (3). The exact cause of atrophoderma as described by Pasini and Pierini remains unknown (1, 4–9). It is a disease that is more common in adolescent and middle-aged females, although there have been cases described in children and in elderly patients. Fur- thermore, it has been reported that this disease can be contracted at birth. Case report Here we report a case study of a 20-year-old man attending our outpatient clinic with a 2-year history of slightly depressed hyper- pigmented patches of the skin of the lower limbs. The patient had noticed that the changes were more visible during autumn and winter, whereas in summer the skin patches become less intense in color. The patient was initially treated as an outpatient with local corticosteroids, and nourishing and neutral creams. The pa- tient was subsequently admitted, presenting with disseminated lesions on the skin of the lower limbs (Fig. 1), with slightly pig- mented and atrophic skin along with irregular borders. The skin lesions varied in size from a few mm to several cm and were clear- ly demarcated from the surrounding healthy skin. Afer admission to the hospital, we carried out the following analyses: sedimen- tation, full blood count, urea, creatinine, hepatogram, transami- nases, anti-DNA, antinuclear antibody (ANA), LE cell, Scl-70, CRP, and serological test for Borrelia. All parameters were within reference ranges. The only collateral fnding that we noticed was subclinical Hashimoto’s thyroiditis with a normal level of thyroid hormones and very high levels of anti-TPO (1,200 in a reference range of < 30 IU/ml). The previously unidentifed thyroiditis was detected by a dermatologist during the hospitalization at our clin- ic because the patient did not have any noticeable symptoms be- fore admission. Moreover, a detailed skin biopsy report, obtained via standard pathology diagnostics services, revealed fattening of the dermal papillae rete ridges, perivascular, perifollicular lym- phocytic infltrate, and clumping of collagen fbers. Abstract Atrophoderma of Pasini and Pierini is a skin atrophy presenting as single or multiple sharply demarcated, hyperpigmented, non-in- durated patches, with a slight depression of the skin, that can converge and form a confluent area with atrophy as a consequence. The condition was frst described by Pasini in 1923 and subsequently by Pierini in 1936. They distinguished this form of atrophy from other diseases and conditions in which the atrophy is morphologically and clinically diferent. The disease was initially asso- ciated with Borrelia burgdorferi infection; however, at present, various theories have emerged for the appearance of the disease, linked to genetic, neurogenetic, and immunological factors. Here we present a patient that was admitted to the hospital due to disseminated lesions on the skin of the lower limbs, with slightly pigmented and atrophic skin along with irregular borders varying in size, from several mm to a few cm, clearly demarcated from the healthy skin, with no history of a tick bite or a family history of similar skin disorders. Keywords: atrophoderma of Pasini and Pierini, atrophy, hyperpigmentation Acta Dermatovenerologica Alpina, Pannonica et Adriatica Acta Dermatovenerol APA Received: 28 June 2018 | Returned for modifcation: 24 October 2018 | Accepted: 29 November 2018 Figure 1 | Atrophoderma of Pasini and Pierini: disseminated lesions on the skin of the lower limbs. Figure 2 | Atrophoderma of Pasini and Pierini: pigmented and atrophic skin characterized by irregular borders.