What are the other Names for this Condition? (Also known as/Synonyms)

• Atrophoderma Vermiculata/Folliculitis Ulerythematosa Reticulata
• Atrophodermia Reticulata Symmetrica Faciei
• Honeycomb Atrophy

What is Atrophoderma Vermiculata? (Definition/Background Information)

• Atrophoderma Vermiculata is a skin disorder that develops when hair follicles get plugged by dead skin. The onset of the skin lesions occur in childhood and are mostly observed on the cheeks. This condition affects the skin resulting in pitted scarring of the cheek, which can cause cosmetic disfigurement
• Atrophoderma Vermiculata (or Folliculitis Ulerythematosa Reticulata) is a rare subtype of keratosis pilaris (or KP, a common skin condition). Keratosis pilaris results in the formation of small bumps on the skin, usually on the arms and legs
• The cause of the condition is unknown, but the risk factors for Atrophoderma Vermiculata include a positive family history, Rombo syndrome, and Loeys-Dietz syndrome
• A diagnosis of Atrophoderma Vermiculata is made by clinical exam and various other diagnostic tools including dermoscopy and wood’s lamp examination
• The treatment of Atrophoderma Vermiculata includes the use of topical moisturizers, steroids, and surgical procedures such as dermabrasion
• In a majority of cases, the prognosis of Atrophoderma Vermiculata with adequate treatment is excellent, since generally it is a harmless condition. However, the overall prognosis may be affected by the severity of any associated underlying disorder

The other types of keratosis pilaris include:

• Erythromelanosis Follicularis Faciei Et Colli: It usually affects the face and neck region
• Keratosis Follicularis Spinulosa Decalvans: It occurs on the scalp and potentially all hair-bearing skin
• Keratosis Pilaris Atrophicans Faciei: The condition usually affects the face
• Ulerythema Ophryogenes: The eyebrows are typically affected

Who gets Atrophoderma Vermiculata? (Age and Sex Distribution)

• Atrophoderma Vermiculata is generally observed in children. However, individuals of a wider age range may be affected
• The condition affects both males and females
• It is seen worldwide and all racial and ethnic groups may be affected

What are the Risk Factors for Atrophoderma Vermiculata? (Predisposing Factors)

The risk factors for Atrophoderma Vermiculata may include the following:

• A positive family history
• Rombo syndrome: A rare genetic disorder that is associated with many skin conditions causing lesions on the body
• Nicolau-Balus syndrome: A rare genetic disorder with milia and syringomas of the skin
• Loeys-Dietz syndrome: A connective tissue disorder that causes aortic aneurysms in children, easy bruising, and joint abnormalities

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Atrophoderma Vermiculata?

Atrophoderma Vermiculata is caused by the plugging of hair follicles by increased keratin debris (dead skin) on certain areas of the body. However, the factors that cause the condition are unknown or remain unidentified.

• Individuals may have a family history of Atrophoderma Vermiculata
• There is no definitive proof that certain types of diet play a role in the development of this skin condition. Taking chocolates or oily food materials are not known to cause the condition
• Atrophoderma Vermiculata (Folliculitis Ulerythematosa Reticulata) is non-contagious and it does not spread from one individual to another. In other words, one cannot contract the condition by interacting closely with the affected individuals. It is not a sexually-transmitted disease

What are the Signs and Symptoms of Atrophoderma Vermiculata?

The signs and symptoms associated with Atrophoderma Vermiculata may include:

• The presence of small elevated benign lesions that appear like a patch of tiny goose bumps, usually present on the cheek (face)
• The skin lesions combine to form depressions, and multiple depressions in a group appear as a honeycomb pattern. Hence, the disorder is also known as Honeycomb Atrophy
• Occasionally, the skin lesions may be present in other parts of the face and body, including on the arms and legs
• The eyebrows, eyelashes, and scalp are generally spared
• The onset of the signs and symptoms take place in childhood. As the child moves into puberty, the signs and symptoms stop progressing
• The skin feels like sandpaper, and occasionally they can itch
• There can be redness of skin around the rashes or bumps (erythema)
• The bumps can either take the surrounding skin color, or even be darker than the surrounding skin color (hyperpigmented)
• Additionally, the signs and symptoms of the underlying disorder, if any, may be observed

Aggravation of the condition may occur under the following circumstances:

• In dry, low-humid conditions, the symptoms may aggravate because of skin dryness. It may get better during summer and worse during dry winter months, due to a lack of humidity
• Tanning of the skin through sun exposure
• Shaving or waxing of skin
• Dry sauna can also aggravate this skin condition

Note: Individuals, nearer to the tropics, may see the condition remain the same without any seasonal variations (all year long).

How is Atrophoderma Vermiculata Diagnosed?

The diagnosis of Atrophoderma Vermiculata/Folliculitis Ulerythematosa Reticulata may involve:

• A complete evaluation of medical history along with a thorough examination of the skin lesions by a dermatologist
• The healthcare provider may also ask many questions related to the individual’s age, family medical history, current medications, cosmetics, body lotions used, other medical conditions, infections, etc.
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Complete blood count (CBC)
• Examination of peripheral blood smear under a microscope by a pathologist
• If secondary infections develop, then a culture test may be done
• Genetic testing to diagnose underlying associated disorder, if any
• In very rare cases, a skin biopsy may be performed: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: If itching is a prominent symptom, then other conditions, such as fungal infections, should be ruled out.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Atrophoderma Vermiculata?

Complications associated with Atrophoderma Vermiculata include:

• Increased psychological stress due to the skin condition
• The depressions caused by the skin lesions my result in pitted scarring of the cheek, which can cause cosmetic disfigurement
• The skin over the lesions may become thin (atrophic)
• Scratching the skin lesions may result in scars on healing
• The signs and symptoms may appear and disappear, even with treatment. The condition can recur

How is Atrophoderma Vermiculata Treated?

There is no definite cure for Atrophoderma Vermiculata after onset of the signs and symptoms. The treatment options may include both medical and surgical treatment measures.

• The medical treatment for Atrophoderma Vermiculata may include:
  • Avoiding hot dry environment
  • Use of moisturizers with urea or lactic acid
  • Topical medicated creams may be administered to remove dead skin (exfoliation therapy). The common medications used include lactic acid, vitamin D, and salicylic acid
  • Use of topical retinoids (tretinoin) and steroids
  • Rarely, the oral retinoid, isotretinoin is used
• The surgical care for Atrophoderma Vermiculata may include:
  • Dermabrasion: It is a surgical procedure to treat cosmetic issues
  • Laser therapy: Despite all the above treatment measures, if no improvement is noted, then laser therapy may be employed
• Additionally, suitable treatment of the underlying and associated disorder may be necessary

Note:

• Isotretinoin should NOT be used on pregnant women, or on women who can potentially become pregnant. This is very important because isotretinoin can cause fetal abnormalities and malformations, during the growth of the fetus in the mother’s womb, termed teratogenic defects of isotretinoin. Hence, a pregnancy test is always performed in women of child-bearing age, before starting treatment with isotretinoin. In addition, all the other elements of the FDA mandated iPledge program must be complied with (see resource list below)
• One has to be patient for the signs and symptoms to get better, since it may take months before showing any improvement. Once the treatment has started, one has to be consistent in following the prescriptions and taking the medications continuously and regularly. Skipping the treatment regimen will not help improve the condition

The following tips are helpful for Atrophoderma Vermiculata/Folliculitis Ulerythematosa Reticulata:

• Keeping the skin moist can help in reducing the signs and symptoms caused by the condition
• If any of the prescribed treatment causes new stinging or burning symptoms, then it is important to stop using them immediately and inform the physician’s office
• Taking care of oneself, being clean and hygienic (especially face and hands), avoiding oily make-ups and creams, drinking lots of water, etc. are all simple practices that may help ensure a faster recovery from the condition
• Avoid excessive washing and scrubbing of the skin; also limit time spent in water
• Completely avoid scratching the affected areas

How can Atrophoderma Vermiculata be Prevented?

Currently, there are no specific methods or guidelines to prevent Atrophoderma Vermiculata. However, in order to prevent aggravation of the condition, the following steps may be considered:

• Use of home humidifiers, in case of dry indoor air
• Use moisturizing creams regularly to prevent dry skin
• Use mild bathing soaps to not aggravate the condition
• Avoid excessive, long duration baths using hot water
• While showering do not use rough scrubbers, it can make the condition worse
• Avoid tanning of the skin
• Avoid shaving or skin waxing

What is the Prognosis of Atrophoderma Vermiculata? (Outcomes/Resolutions)

• The prognosis of Atrophoderma Vermiculata/Folliculitis Ulerythematosa Reticulata is excellent in a majority of cases, since it is a benign/harmless condition. However, the overall prognosis may depend upon the severity of the underlying condition, if any present
• Severe cases may lead to cosmetic issues, which can be addressed through appropriate treatment measures. In some individuals, Atrophoderma Vermiculata signs and symptoms can get better as one ages
• Regular follow up visits with the healthcare providers are important

Additional and Relevant Useful Information for Atrophoderma Vermiculata:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for Atrophoderma Vermiculata. However, it helps to be clean and hygienic, which will help the condition from getting worse