Medical Care
No treatment is consistently effective, but some patients respond to topical corticosteroids, antibiotics, or antimalarials.
Results of medical treatment with antibiotics have been inconclusive. In patients with new early-stage idiopathic atrophoderma of Pasini and Pierini, especially those with a positive B burgdorferi antibody titer, the standard recommended therapy for Lyme disease is suggested. A retrospective evaluation of 25 patients treated with oral penicillin (2 million IU/d) or oral tetracycline (500 mg 3 times/d) for 2-3 weeks showed clinical improvement with no new active lesions in 20 patients. The same study also showed no progressive disease in 4 of 6 patients who did not receive treatment.
A report of a 35-year-old woman with elevated B burgdorferi antibody (IgM) titer and atrophoderma of Pasini and Pierini describes clinical improvement with no new lesions with doxycycline (200 mg/d) for 6 weeks. [19]
Anecdotal reports have described beneficial treatment with the use of hydroxychloroquine [20] and potassium aminobenzoate.
Surgical Care
Surgical treatment has generally not been helpful in improving the appearance of the atrophied skin.
Arpey et al [21] showed the Q-switched alexandrite laser (755 nm) to be effective in diminishing the hyperpigmentation by 50% after 3 treatments in one case.
Long-Term Monitoring
Once the diagnosis is established, outpatient care consists of following up for the development of new lesions and the involvement of new areas. Ultrasonography may be used for diagnosis and follow-up.
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Early lesion demonstrating diagnostic "cliff-drop" border to atrophy. Courtesy of Joe Eastern, MD.
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Older lesion showing typical pigmentation and classic "cliff-drop" border. Courtesy of Joe Eastern, MD.
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Single ovoid patch of atrophoderma on the back of a young adult female.
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Atrophic hyperpigmented patch with characteristic “cliff-drop” borders.
