A 10-year-old boy presented with multiple asymptomatic small pit like areas of atrophy present over the preceding 8 years. There was no history of inflammatory papules prior to the development of the scars. Family history was non-contributory. Cutaneous examination revealed bilaterally symmetrical pitted, atrophic and depressed scars in a honeycomb pattern. (Fig. 1) Histopathology showed epidermal atrophy, dilated capillaries and sclerosis of dermal collagen. A diagnosis of Atrophoderma vermiculatum was made; topical tretinoin was prescribed.

Fig. 1 Pitted, atrophic and depressed scars in a honeycomb pattern.

Atrophoderma vermiculatum, a disorder limited to the face usually has its onset during childhood or puberty and has a slow progressive course. The underlying pathogenesis appears to be abnormal follicular hyper-keratinization. It may be associated with congenital heart block, neurofibromatosis, oligophrenia or Down syndrome. Other atrophies which simulate this are post-acne scarring (history of acne, postpubertal onset) and viral varioliform scarring (history of viral exanthem). Various topical treatments, including emollients, corticosteroids, tretinoin and keratolytics, have not shown consistent benefit.