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Journal of the American Academy of Dermatology
Volume 77, n° 5
pages 930-937 (novembre 2017)
Doi : 10.1016/j.jaad.2017.02.044
accepted : 16 February 2017

Idiopathic atrophoderma of Pasini and Pierini: A case study of collagen and elastin texture by multiphoton microscopy

Gislaine Vieira-Damiani, PhD a, Denise Lage, PhD b, Patrícia Érica Christofoletti Daldon, PhD b, Caroline Romanelli Tibúrcio Alves, MD b, Maria Letícia Cintra, PhD a, , Konradin Metze, PhD a, Javier Adur, PhD c, Vitor B. Pelegati, PhD c, Hernandes F. Carvalho, PhD c, d, e, Carlos Lenz Cesar, PhD c, d, f
a Department of Pathology, Medical School, University of Campinas, Campinas, Brazil 
c Biophotonics Group, Department of Quantum Electronics, Institute of Physics Gleb Wataghin, University of Campinas, Campinas, Brazil 
d National Institute of Science and Technology on Photonics Applied to Cell Biology, University of Campinas, Campinas, Brazil 
e Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil 
b Department of Dermatology, Celso Pierro Hospital, Pontifical Catholic University of Campinas, Campinas, Brazil 
f Department of Physics, Federal University of Ceara, Fortaleza, Brazil 

Reprint requests: Maria Letícia Cintra, PhD, Department of Pathology, Medical School, UNICAMP, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP CEP: 13083-887, Brazil.Department of PathologyMedical SchoolUNICAMPRua Tessália Vieira de Camargo126, Cidade Universitária Zeferino VazCampinasSPCEP: 13083-887Brazil

The diagnosis of idiopathic atrophoderma of Pasini and Pierini (IAPP) relies on typical clinical features, particularly distinctive pigmented ovular/round depressed plaques. Histologic examination often reveals no obvious changes, but patterns of collagen distribution, using multiphoton imaging and second harmonic generation can help track hidden details of tissue organization contributing to atrophy.


To identify histologic features that distinguish IAPP from unaffected skin.


Eleven patients were included for conventional analyses. Masson trichrome– and Unna-Tanzer orcein–stained sections were evaluated using automated morphometry. Hematoxylin-eosin–stained sections were analyzed by multiphoton imaging using 2-photon excited fluorescence and second harmonic generation.


No abnormalities were found under light microscopy or by automated quantification. Multiphoton imaging revealed no difference in optical density of either collagen or elastic fibers in lesioned and unaffected skin; however, horizontal collagen fiber organization in lesion specimens increased toward the lower dermis, whereas elastic fibers featured greater disorganization within the upper dermis.


The low number of patients evaluated.


The atrophic appearance of IAPP lesions reflects changes in organization, but not in collagen and elastic tissue content. Minute organizational differences that are imperceptible to the experienced pathologist and undetectable by automated analyses were revealed by multiphoton analyses, particularly second harmonic generation, in association with texture analyses.

The full text of this article is available in PDF format.

Key words : atrophoderma, atrophy, collagen fibers, elastic fibers, idiopathic atrophoderma of Pasini and Pierini, morphometry, pathology, scleroderma, SHG, second harmonic generation, TPEF, 2-photon excited fluorescence

Abbreviations used : AR, FFT, GLCM, H&E, IAPP, ROI, ROI 1, ROI 2, ROI 3, SHG, TPEF

 Funding sources: This study was funded by the São Paulo Research Foundation (08/57906–3), the National Council for Scientific and Technological Development (573913/2008–0), and the Biologia das Doenças Neoplásicas da Medula Óssea (FAPESP grant 11/51959-0) project with fellowship support from CNPq (310518/2015-6).
 Conflicts of interest: None declared.

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