Iatrogenic Anetoderma of Prematurity: A Case Report and Review of the Literature

Abstract

Anetoderma is a skin disorder characterized by focal loss of elastic tissue in the mid dermis, resulting in localized areas of macular depressions or pouchlike herniations of skin. An iatrogenic form of anetoderma has been rarely described in extremely premature infants and has been related to the placement of monitoring devices on the patient skin. Because of the increasing survival of extremely premature infants, it is easy to foresee that the prevalence of anetoderma of prematurity will increase in the next future. Although it is a benign lesion, it persists over time and can lead to significant aesthetic damage with need for surgical correction. Sometimes the diagnosis can be difficult, especially when the atrophic lesions become evident after discharge. Here, we report on a premature infant born at 24 weeks of gestation, who developed multiple anetodermic patches of skin on the trunk at the sites where electrocardiographic electrodes were previously applied. The knowledge of the disease can encourage a more careful management of the skin of extremely premature babies and aid the physicians to diagnose the disease when anetoderma patches are first encountered later in childhood.

Intrauterine big toenail imprints: A new cause of congenital skin dimples

“…At this point in gestation, the keratinization process of nails has already taken place and repeated contact with the fragile skin in the same area could potentially cause permanent damage. Immature skin is known to be prone to scar formation from minor trauma as evidenced by premature neonates who may develop scars from routine medical procedures, such as the placement of electrocardiographic leads . This hypothesis of toenail impingement on the skin during gestation may provide a simple explanation for otherwise unexplained SD in healthy infants.…”

Ultrastructural aspects of primary anetoderma

“…In the primary form, lesions appear spontaneously on clinically normal skin, without any preceding dermatosis, and, despite its unclear pathogenesis, some authors report the association with autoimmune diseases . Familial cases are rare, with both autosomal dominant and recessive inheritance reported . Secondary anetoderma is preceded by inflammatory, infectious or neoplastic conditions and may be related to an abnormal repair mechanism of injured skin …”

“…Anetoderma ( anetos , Greek for slack), also known as macular atrophy, is a rare elastolytic disorder characterized by circumscribed areas of flaccid skin due to focal loss of dermal elastic tissue, resulting in normochromic or erythematous papules and plaques with a wrinkled and atrophic surface . Older lesions may form soft sack‐like projections, which yield on pressure .…”

“…Anetoderma has 2 forms: primary (idiopathic, develops on clinically normal skin) and secondary (develops on the same area as a previous dermatosis) . Although it is a benign condition, it persists over time and can lead to significant esthetic damage and psychological disorders . The diagnosis is based on its clinical findings in addition to histopathological examination using special elastic tissue stains …”

Atrophic Lesion on the Abdomen

“…Secondary anetoderma is a reactive process linked to a known preceding inflammatory, infectious, autoimmune, or drug-induced condition. 3 On histopathology, both primary and secondary anetoderma are characterized by a loss of elastic tissue or elastin fibers in the superficial to mid dermis. 2 Anetoderma of prematurity was first described in 1996 by Prizant et al 4 in 9 extremely premature (24-29 weeks' gestation) infants in neonatal intensive care units (NICUs).…”