Anetodermiya – a focal atrophy of skin with not clear etiology at which there is a primary defeat of elastichesky fibers terms. As symptoms of this disease serves emergence on integuments of a trunk and extremities of the centers of various form and the sizes which level is below or the surfaces of invariable skin are higher (depending on a disease form). Diagnostics of an anetodermiya is based on data of dermatological survey, in disputable cases make a skin biopsy in the defeat centers with further histologic studying. In view of uncertainty of an etiology of a disease specific treatment is not developed, use some antibiotics, vitamin medicines, means improving regeneration of fabrics.
Anetodermiya, or a spotty atrophy of skin, presumably is a multiple-factor disease at which there is a defeat of elastichesky fibers terms to their degradation and development of the accompanying violations (thinning of epidermis, vascular anomalies). Mainly strikes women aged from 20 up to 40 years living in the central part of Europe and at the natives of this region living in other countries, the spotty atrophy of skin arises very seldom. It refutes the genetic theories explaining development of an anetodermiya by mutations of some genes.
Today allocate primary and secondary form of a disease – an etiology of the first just and represents a scientific problem whereas the second arises on the place of tubercular, syphilitic and other inflammatory damages of skin. Most of researchers considers that it is impossible to compare primary and secondary form of this pathology as, despite external similarity, in their development probably absolutely different processes and factors play a role. Anetodermiya meets as an independent disease, and as a part of simptomokompleks of a disease of Blegvada-Hakstgauzen – genetic pathology at which the cataract and osteoporosis is also observed.
Most of researchers inclines to opinion that in development of an anetodermiya the large role is played by a combination of nervous, endocrine, exchange and immunological violations. Participation in development of a spotty atrophy of skin of such microorganisms as spirokheta is also almost proved. Indirect demonstrations of it is residence of the most part of patients in Central Europe (will practically coincide with an area of distribution of Br. burdorferi) and positive reaction to treatment of an anetodermiya antibiotics of a penicillinic row. Besides, the case of the birth of the baby with a spotty atrophy which mother suffered from intrauterine borreliosis is described.
The pathogenesis of an anetodermiya is characterized by a certain staging. Originally in a term there are nonspecific inflammatory phenomena – lymphocytic infiltration with participation of neutrophils and plasmatic cages. As a rule, this stage almost asymptomatic therefore in dermatology patients with a spotty atrophy of skin at this stage seldom come to light. Then infiltration is a little allowed, however all the same in fabrics there is a small amount of cages of immune system. It is supposed that macrophages and neutrophils begin to produce an elastaza which destroys elastinovy fibers terms, starting development of an anetodermiya. Other theories specify that as the reason of development of violations of this kind elastin synthesis reduction, balance shift can serve in the elastaza-antielastaz system or problems at release of amino acid .
The final result of the above-stated processes at an anetodermiya is almost total disappearance of elastic fibers in a term, partial degradation of collagen, thinning of epidermis. Process does not extend to all skin, and has focal character, the reasons of it are also unknown today. Considering that there are several clinical forms of an anetodermiya, it is supposed that the pathogenesis of this state can proceed in the different ways. However a result of everyone one – almost irreversible focal dystrophy of integuments.
Besides division of an anetodermiya on primary and secondary, there is also a classification of this state by the clinical forms which are characterized by different symptoms and manifestations. The reasons of such distinctions are at the moment studied insufficiently, presumably development of this or that simptomokompleks is caused by many factors at once. Carry a possible etiology of an anetodermiya, reactivity of an organism, activity of immune system, neuroendocrine violations to them. Dermatologists allocate three clinical types of this pathology.
The classical form (Yadasson's type) is the most common form of an anetodermiya therefore its clinical current is considered the most studied. Originally on a surface of integuments of a trunk, extremities, necks and persons arise the spots with a diameter of 5-10 millimeters having pinkish coloring. A characteristic diagnostic sign of an anetodermiya like Yadasson is lack of spots on palms and soles. For 7-12 days increase in diameter of the center which reaches finally 2-3 centimeters is observed. No subjective feelings (morbidity, an itch) at development of this type of an anetodermiya arise. Then sharply there comes the atrophy stage – skin on a surface of the centers becomes thinner, is easily rumpled, its surface becomes pale, the Level of the centers of defeat is slightly higher than normal integuments that gives them a type of gryzhepodobny protrusion. Atrophic changes at an anetodermiya begin in the center of the center, gradually extending to the periphery.
Anetodermiya like Shvenningera-Buzzi differs from the previous option in almost total absence of an inflammatory stage of a disease. On not changed skin of a back and the top extremities suddenly there are centers with a diameter of 2-3 centimeters which are sharply acting over surrounding fabrics. First these protrusions dense, but the atrophy, integuments on the sites struck with an anetodermiya quickly enough develops become covered by wrinkles, quite often on them there are teleangiektaziya. Also in the anetodermiya centers like Shvenningera-Buzzi small small knots which are expansions of capillaries terms often are found.
Anetodermiya like Pellizari (urtikarno-edematous type) is characterized by initial development of skin rashes in the form of the blisters similar in the appearance to a small tortoiseshell. Difference of this option of an atrophy of skin from a true urtikariya is total absence of subjective violations, including an itch. In several days on the place of edematous elements the atrophic changes characteristic of an anetodermiya begin to develop.
The course of a disease carries chronic and sometimes recidivous character. Permission of the atrophic centers at an anetodermiya of any type does not occur, they remain for the rest of life, by therapeutic methods it is possible to slow down atrophic processes at an early stage.
Diagnostics of an anetodermiya
Diagnostics of an anetodermiya is most often made on the basis of dermatological survey, sometimes carry out a skin biopsy in the defeat centers for the histologic analysis. Results of survey of skin depend on clinical type of a disease and a stage of its development. The general for all options of an anetodermiya are such manifestations as thinning and an easy sminayemost of skin in the centers, its pallor, gryzhevidny protrusion (the zapadeniye of integuments is in rare instances observed on the contrary). At a palpation one of the most characteristic symptoms of an anetodermiya – comes to light when pressing the pathological center a finger as though fails in emptiness. It found the reflection in the name of this pathology (from the Greek anetos - emptiness).
The histologic researches made at initial stages of development of an anetodermiya often reveal moderate lymphocytic infiltration with primary perivaskulyarny localization. Among other manifestations of a nonspecific inflammation - existence in leather of macrophages, neutrophils, sometimes come to light also plazmotsita. At an atrophic stage of an anetodermiya lymphocytic infiltration is expressed much more weakly, however reduction or total absence of elastichesky fibers, existence of inclusions in fibroblasta, thinning of epidermis comes to light. At an anetodermiya like Shvenningera-Buzzi vascular disorders in the form of expansions of capillaries terms can be found. Differential diagnostics should be carried out with such states as an atrophic form red flat depriving, a focal sklerodermiya, Pazini-Pyerini's atrofodermiya.
Treatment of an anetodermiya
Specific therapy of an anetodermiya is not developed as definitely the reasons causing such processes in skin still are not established. From medicines of the general action reduction of speed of an atrophy is caused by antibiotics (penicillin), some antimalarial means, vitamin and mineral complexes. Most likely, their efficiency at an anetodermiya is connected with reduction of influence of infectious agents (such as Br. burdorferi), and also the all-strengthening action on an organism. According to some information, gialuronidaza injections in the defeat centers also slow down atrophic processes and reduce expressiveness of displays of a disease.
Local treatment also includes introduction of a gialuronidaza to the fabrics struck with an anetodermiya by means of an electrophoresis method. There are instructions on beneficial influence of a fonoforez with tocopherol and a dimethyl sulfoxide. From other local medicines which are used in therapy of an anetodermiya especially often apply stimulators of regeneration of fabrics – . Sometimes for treatment of an anetodermiya like Shvenningera-Buzzi use antitrombotichesky medicines – aminocaproic acid, geparinovy ointment. However any methods of treatment are effective only at initial stages of development of a disease. In case of already created atrophy to return skin to an initial fortune it will not be come into any more.
Forecast and prevention of an anetodermiya
Even the heaviest current of an anetodermiya does not threaten the patient's life, in this regard the forecast of a disease favorable. However concerning recovery most often prospects are quite doubtful. Treatment of an anetodermiya can be effective only at initial, inflammatory stages of pathology, and at them symptoms or are expressed very poorly (at Yadasson's type), or at all are absent (Shvenningera-Buzzi's type). Besides, not always the dermatologist in due time distinguishes this disease as it is not among widespread. The late address to the expert and difficulties in diagnostics lead to the fact that treatment of an anetodermiya is begun at already rather expressed atrophic phenomena which in most cases are irreversible.