Anetoderma Workup

Updated: Apr 06, 2017
  • Author: Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Laboratory Studies

Laboratory testing for the presence of thyroid autoantibodies [55] and antiphospholipid antibodies in all patients who present with primary anetoderma is recommended. Antiphospholipid antibody tests include lupus anticoagulant, all isotypes of anticardiolipin, and anti-β2-glycoprotein I antibodies. The following laboratory tests may be considered if clinically indicated:

  • Antinuclear antibody (ANA) test, complement (C3, C4)

  • Other autoantibodies (anti-Ro, anti-La, antimitochondria, anti-smooth muscle)

  • ACE level

  • CBC count

  • Lyme disease titers

  • QuantiFERON assay

  • Rapid plasma reagin (RPR)/Venereal Disease Research Laboratory (VDRL) test

  • Sedimentation rate

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Histologic Findings

A perivascular and periadnexal lymphohistiocytic infiltrate is seen in the papillary dermis, upper reticular dermis, or both. Marked loss of elastic fibers is observed, although fine microfibrils may remain. Collagen fibers appear normal. Desmosine, a cross-linking compound found only in elastin, is reduced in lesional skin. Early lesions may show a pronounced monocytic infiltrate of predominantly T helper lymphocytes, but occasionally, the predominant cell types are histiocytes, neutrophils, or eosinophils. Scattered macrophages showing elastophagocytosis may be present. Microthromboses may be seen in individuals with anetoderma and antiphospholipid antibodies.

Direct immunofluorescence is usually not helpful, but findings similar to those of lupus erythematosus may be found, [56] with granular deposits of immunoglobulin G (IgG), immunoglobulin M (IgM), and/or complement (C3) along the dermoepidermal junction and blood vessels. Sometimes, fibrillar immunoglobulin and complement deposits are present in the papillary dermis. This probably corresponds to deposition on elastic tissue, although indirect immunofluorescence studies have failed to demonstrate elastic fiber autoantibodies.

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