What is Anetoderma?
The word anetoderma comes from two Greek words – ‘anetos’ which means relaxed and ‘derma’ which means skin. This condition was first mentioned in medical documentation by Jadassohn in 1892. Simply put, anetoderma is a harmless condition in which your skin loses its normal elasticity in certain areas, resulting in patches of loose skin. These patches might look like saggy areas, small depressions, wrinkled spots, or even bulges, surrounded by normal skin. Their color can vary, presenting as the same color as your skin, or appearing white, grey, brown, or blue. The size of these patches can also differ, from tiny points to larger spots. Often, these patches show up on the main body or the upper parts of your arms and legs. Once this condition starts, it generally stays active for about 15 years. To date, there are no recorded cases of this condition clearing up on its own.
What Causes Anetoderma?
Anetoderma, a skin condition that causes sagging or wrinkling, can be categorized into five different types: primary anetoderma, secondary anetoderma, drug-induced anetoderma, familial anetoderma, and anetoderma related to prematurity.
Primary anetoderma appears on skin that was previously normal. There are two traditional categories of primary anetoderma, known as the Jadassohn-Pellizzari type and the Schweninger-Buzzi type. The Jadassohn-Pellizzari type of anetoderma develops after inflammatory skin changes, while the Schweninger-Buzzi type appears on skin that previously looked normal. Despite the cause, both types look the same under a microscope and progress in the same manner.
Secondary anetoderma emerges on skin already affected by another condition. This type of anetoderma is commonly associated with acne and chickenpox but can also occur with other conditions like syphilis, sarcoidosis (a disease that causes inflammation in different organs), leprosy, Lyme disease, among others. Furthermore, episodes of secondary anetoderma have been observed in patients with HIV and various autoimmune diseases such as lupus, Graves disease, and Addison disease.
The medication called penicillamine can cause drug-induced anetoderma. This happens because penicillamine interferes with the process necessary for the formation of elastic fibers in the skin.
Familial anetoderma, which is genetic, is not commonly found. It usually shows up in the first ten years of life and sometimes comes with conditions affecting the bones, nerves, and eyes.
Anetoderma of prematurity affects premature babies who were born between twenty-four and twenty-nine weeks of gestation and were cared for in a neonatal intensive care unit.
Risk Factors and Frequency for Anetoderma
Anetoderma is an unusual condition and we don’t have exact numbers on how common it is. People of all ages can be affected, but it’s most often seen in adults between the ages of 20 and 40. More women than men tend to have this condition, but it doesn’t seem to favor any particular race.
- Anetoderma is a rare disorder without a known exact prevalence.
- Although it can occur in people of all ages, it’s most common in adults aged 20 to 40.
- It’s more common in women than men.
- The condition does not favor any specific race.
Signs and Symptoms of Anetoderma
Anetoderma is a condition that initially shows no signs or causes itchiness. The initial indicators, known as lesions, may appear as red spots, patches, or lumps on the skin. These lesions grow until they reach a final size and can occur in areas where the skin has been affected by other conditions, a characteristic of the secondary type of anetoderma. Lesions can either be a solitary case or occur in multiple locations.
The lesions create specific patterns on the skin. The skin in these areas might look loose and wrinkled, sagging inward or bulging outward. When touched, the normal skin around the lesion’s edge can be felt, while the central part of the lesion dips in when pressure is applied. Once lesions reach their final stage, they do not change over time.
Testing for Anetoderma
The diagnosis of a skin condition known as anetoderma can normally be made simply by examining the skin. However, if it’s hard for the doctor to confirm, a skin biopsy may be needed. This is typically performed using a procedure called a punch biopsy, which can indeed include a layer of the skin called the mid-dermis. Once anetoderma is confirmed, it’s also important to identify which specific type of the condition a patient has. The patient’s medical history can be key in making this determination.
Further examination, such as electron microscopy (a kind of super-magnifying imaging technique), can help provide more information. For instance, signs like fragmented elastic fibers and the process of ‘elastophagocytosis’ (where elastic tissue is damaged or destroyed) can be seen in the skin affected by anetoderma.
‘Desmosine’ is a substance that’s a big part of elastic tissue, so it’s been used to measure the level of elasticity in the skin. In people with anetoderma, there is usually a significant decrease in this elasticity.
For patients with one particular type of anetoderma, known as primary anetoderma, additional investigation is required to discover if there are any other diseases present. The tests that are chosen will depend on what the doctor suspects, based on your medical history and physical exam.
Primary anetoderma has been linked with ‘antiphospholipid antibodies’, so people diagnosed with this condition should always be tested for these antibodies. This is important, even if the patient has no history of conditions like spontaneous miscarriages or clotting diseases, which can be associated with these antibodies.
Treatment Options for Anetoderma
Anetoderma is a skin condition that can be tricky to treat. Although many treatments have been tried, none have proven to be effective once the condition is already established. One medication, called Colchicine, may help prevent new signs of the primary type of anetoderma from showing up on the skin.
Anetoderma is sometimes secondary to another skin condition, meaning it develops as a result of that condition. In those cases, managing the original skin problem might help prevent new spots of anetoderma from forming.
There are also many other treatments that have been tested, but so far, we don’t have enough scientific evidence to say they work. Some examples are cryotherapy (a procedure that uses extreme cold to destroy abnormal tissue), injecting steroids directly into the lesion, and various medications such as colchicine, hydroxychloroquine, vitamin E, penicillin, epsilon-aminocaproic acid, niacin, dapsone, and phenytoin. These medications may be given orally or topically.
If an established lesion becomes a significant problem, it can be surgically removed. However, this will leave a permanent scar. Another option could be laser treatment, which may improve how lesions look. But again, reports of this being effective are limited, so it’s not a guaranteed solution.
What else can Anetoderma be?
Some diseases are often confused with anetoderma. These are primarily conditions that affect the skin’s elasticity, leading to skin thinning similar to anetoderma. Here are some examples:
- Mid-dermal elastolysis is characterized by a loss of elastic fibers in the middle layer of the skin. This condition results in widespread, distinct, thin, and wrinkled skin patches, usually on the torso and upper arms.
- Acquired cutis laxa is another condition where elastic fibers are lost, causing the skin to sag and look loose all over the body.
- Granulomatous slack skin disease is a rare type of skin lymphoma, a cancer of the immune cells. It is distinguished by elastic fibers being engulfed by immune cells, leading to symptoms such as red, droopy folds of loose skin.
- Atrophoderma of Pasini and Pierini manifest as brown, gray or purple spots or patches. These spots have a clear, sloping border when felt and are typically located on the torso.
It’s important for doctors to distinguish between these conditions and anetoderma to ensure proper treatment.
What to expect with Anetoderma
Once anetoderma, a skin condition where certain areas become saggy, appears, the affected areas do not change or heal over time. They remain as they are.
Possible Complications When Diagnosed with Anetoderma
Primary anetoderma, especially when associated with antiphospholipid antibodies, can possibly lead to certain problems many years after diagnosis. These issues might include blood clots, inflammation of the veins near the skin’s surface, and spontaneous miscarriages. Because of these potential problems, it’s key that everyone with primary anetoderma gets tested for antiphospholipid antibodies, even if they have no history of blood clots.
Possible Complications:
- Blood clotting events
- Inflammation of veins near skin surface
- Spontaneous miscarriages
Preventing Anetoderma
Anetoderma is a harmless skin condition. Once it’s identified, it’s crucial to determine what type of anetoderma you have. This information will help you understand how the condition might progress and enables you to seek treatment for any underlying causes of the so-called “secondary” type of anetoderma, preventing the development of new skin irregularities. You should be informed about the nature of the condition, what to expect as it progresses, and to understand that once these skin changes appear, they do not vanish on their own.
