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Chapter 57: Anetoderma

Naomi Labonté-Truong; Catherine Maari; Julie Powell

ANETODERMA

Therapeutic Approach

Anetoderma is a rare disorder characterized histologically by a loss of elastic tissue in the dermis. Clinically, lesions consist of multiple, circumscribed areas of flaccid skin that may be associated with wrinkling, atrophic depressions, or saccular protrusions. While primary anetoderma occurs in areas of previously normal skin, secondary anetoderma develops at sites of previous dermatoses. Both primary and secondary types of anetoderma may be associated with underlying systemic conditions, including antiphospholipid syndrome, thus warranting further evaluation. Anetoderma is a benign condition with no regularly effective treatment at the present time. There are no reports of spontaneous regression. In secondary anetoderma, treatment of the primary skin disorder resulting in anetoderma may reduce the risk of developing new lesions. See Table 57-1.

Table 57-1Anetoderma Treatment Table
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Table 57-1 Anetoderma Treatment Table
MEDICATION NAME INDICATION MECHANISM OF ACTION DOSING ADVERSE EFFECTS SUGGESTED MONITORING LEVEL OF EVIDENCE [REFERENCE]
Topical Therapy
Topical corticosteroids PA, SA Anti-inflammatory and antiproliferative effects Reports include fluocinonide, mometasone, and clobetasone butyrate for up to 12 mo Cutaneous atrophy, local irritation, hypersensitivity None IV1-4
Intralesional corticosteroids PA, SA Anti-inflammatory and antiproliferative effects Dosing NS Cutaneous atrophy None IV5,6
Topical vitamin E PA, SA Antioxidant 6-mo duration Contact hypersensitivity None IV7
Systemic Therapy
Oral penicillin G PA, SA due to secondary syphilis Inhibition of bacterial cell wall synthesis Dosing NS Diarrhea, nausea, vomiting candidiasis None IV8,9,6
Doxycycline Borrelia burgdorferi-associated SA In vitro inhibition of matrix metalloproteinases, antimicrobial activity

200 mg QD for 3 wk

100 mg BID for 4 wk

 Esophageal injury, photosensitivity None IV10,11
Tetracycline PA, SA Inhibition of bacterial protein synthesis via binding of the 30S ribosomal unit 1 g QD for 3 wk, 250 mg QD Esophageal injury, photosensitivity None IV12,16
Aspirin SA with underlying APLS Inhibition of platelet aggregation and anti-inflammatory properties 100 mg QD up to 1 y Hemorrhage, hepatitis None IV13,14,16
Enoxaparin SA with underlying APLS Anticoagulant 40 mg subcutaneously BID (duration NS) Anemia, hemorrhage None IV15
Phenytoin PA, SA Unknown Dosing NS NS NS IV6
Dapsone PA, SA Inhibition of neutrophil chemotaxis 50-100 mg QD for 3 mo Hemolytic anemia, methemoglobinemia, leukopenia, agranulocytosis, peripheral neuropathy, nausea, abdominal pain, hypersensitivity Baseline: G6PD, CBC, CMP. Repeat CBC and CMP periodically, with increased frequency when dose is increased IV6,16
Vitamin E PA, SA Antioxidant 1600 units QD for 4 mo NS None IV6
Niacin (nicotinate) PA, SA Unknown NS NS None IV6
Epsilon-aminocaproic acid PA, SA Lysine derivative with anti-fibrinolytic activity via regulation of proteolytic enzymes 4 g every 6 h (duration NS) NS None IV17
Colchicine PA, SA Inhibition of neutrophil migration and phagocytosis 1-1.5 mg QD up to 7 mo Diarrhea, nausea, vomiting abdominal pain Periodic ...

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