[Reprinted from the Journal of Cutaneous and Genito-Urinary Diseases for April, 1895.] 
A CASE OF IDIOPATHIC ATROPHY OF THE SKIN. 
BY GEORGE T. ELLIOT, M. D., 
New York City. 
THERE are only a limited number of cases of idiopathic atrophy 
of the skin recorded in medical literature, as may be seen in 
Dr. Bronson's * recent article and report of a superb example 
of the process. He has carefully collected those known, so that I need 
only cite his paper as a source for information on the subject, and I 
would, therefore, only add one more case to the list, which may possibly 
be of interest since, being for some months under observation, certain 
features in the mode of its extension could be observed and followed. 
Male, German, aged forty-five, in the liquor business, consulted me 
February 25, 1889, for an ulcer on the left ankle, arising from a slight 
traumatism. The veins of the leg and feet were extremely varicose, 
and examination of the knee and thigh revealed the curious condition 
to be described in this article, and to wdiich the patient had not made 
any reference. He stated that he was in robust health, though from 
time to time he had attacks of rheumatism. His functional condition 
was perfectly good. He was tall and slight in build. No history 
pointing to syphilis or to any chronic intoxication was obtainable. 
When a child, he had had an eczematous eruption in both popliteal 
spaces and ulcerations on the legs. Both had been treated and healed, 
the latter leaving scars still visible. About the age of tw'enty-five, he 
had been struck on the left knee by a ball, and he had been lame for 
some time after. Some thirteen years ago he had been in the habit of 
jumping a great deal, both from heights and when on the ground. As 
nearly as he could remember, the cutaneous changes had begun about 
the left knee some fourteen or fifteen years ago, and they had slowly 
progressed up the thigh. When I saw him, the affected area began 
anteriorly about three inches below the left Poupart's ligament, and 
posteriorly from the middle of the gluteal region. From these points, 
* E. B. Bronson. Journ. Catan, and Gen.-Urin. Dis., January, 1895. 
Copyright, 1895, by D. Appleton and Company. 2 
Original Communications. 
the changes extended over the entire skin of the thigh and nates down 
to and including the knee. The affected surface was completely atro- 
phied, excessively thin, dry, wrinkled, and loose, not hound down, of a 
dark red, without any traces of the hairs, and scaly. The veins were 
very large, prominent and tortuous. No subjective symptoms were 
mentioned, nor was there hypersestbesia, or anaesthesia of the surface. 
The atrophic area was sharply limited and defined below by normal 
skin, but the upper boundary was slightly diffuse and continuous with 
a narrow, purplish-red zone. This zone was not elevated nor did it 
appear oedematous or swollen. It was more marked on the right knee, 
where the process was beginning and occupied only a space about two 
inches by four. This area was of recent date, and the patient stated 
that he had first noticed a purplish blush over the knee, followed in a 
short time by a varicose dilatation of the veins and a gradual thin- 
ning of the skin. Whether this description was exact or not I will not 
attempt to say, but the man was under observation until June, 1889, 
and it was seen that the purplish zone extended slowly up the thigh, 
and progressively as it advanced the veins became dilated and varicose, 
the skin atrophic, and the hairs disappeared, so that a condition en- 
tirely similar to that on the left thigh resulted. The ulcer on the ankle 
having been healed, the patient has no longer been seen. Unfortu- 
dately, specimens for microscopic study were refused. 
With the exception of its more limited extent and the absence of 
subjective symptoms of all kinds, this case may be said to correspond 
very accurately in its clinical phenomena to Bronson's. It appears, 
however, to me that the most important feature shown was the pur- 
plish-red zone bounding the advancing area of atrophy, and which, 
progressively as it spread, was followed by the atrophic metamor- 
phosis, a symptom not mentioned as occurring in Bronson's case. The 
process began at the left knee, and extended upward and peripherally 
so as to occupy the entire thigh ; but while at its point of inception 
the limitation toward the normal skin was sharp and incisively definite, 
above, the atrophic area gradually merged into the purplish-red zone, 
and this latter into the normal skin. The same appearances were also 
noted over the right knee, and here slow extension was seen and fol- 
lowed, so that it would appear that this purplish-red area was the pri- 
mary step in the process, and the atrophy was only its consequence. 
What pathological condition was represented by this clinical symptom 
it is certainly difficult to say, and rather useless to speculate upon, in 
view of the fact that the course alone of the process could be observed, 
while the changes in the skin itself were not. I would, therefore, 
only state that in my opinion the advancing cyanotic zone was the A Case of Idiopathic Atrophy of the Skin. 
3 
primary step and the most important part of the process, the atrophy 
being secondary. What was the setiological factor or factors in the 
production of this progressive venous stasis and subsequent atrophy 
of the skin can also not be stated. The blow on the left knee from 
the ball might be regarded as an aetiological factor, but that would not 
explain the development of the process on the right knee a number of 
years later. The habit of jumping, acquired by the patient, can like- 
wise be excluded, as the primary changes had already existed about the 
left knee for a year or more before. In this case, therefore, as in the 
others recorded, the same conclusion is reached-that the cause of the 
atrophy is unknown and obscure, and no satisfactory explanation for its 
occurrence and existence can be given. 
IJj. West Thirty-third Street.