title: Idiopathic atrophoderma of Pasini and Pierini: A case study of collagen and elastin texture by multiphoton microscopy.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To identify histologic features that distinguish IAPP from unaffected skin.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The low number of patients evaluated.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, Medical School, University of Campinas, Campinas, Brazil.
authors.forename: Gislaine
authors.initials: G
authors.lastname: Vieira-Damiani
authors.affiliation: Department of Dermatology, Celso Pierro Hospital, Pontifical Catholic University of Campinas, Campinas, Brazil.
authors.forename: Denise
authors.initials: D
authors.lastname: Lage
authors.affiliation: Department of Dermatology, Celso Pierro Hospital, Pontifical Catholic University of Campinas, Campinas, Brazil.
authors.forename: Patrícia Érica
authors.initials: PÉ
authors.lastname: Christofoletti Daldon
authors.affiliation: Department of Dermatology, Celso Pierro Hospital, Pontifical Catholic University of Campinas, Campinas, Brazil.
authors.forename: Caroline Romanelli
authors.initials: CR
authors.lastname: Tibúrcio Alves
authors.affiliation: Department of Pathology, Medical School, University of Campinas, Campinas, Brazil. Electronic address: marialet@fcm.unicamp.br.
authors.forename: Maria Letícia
authors.initials: ML
authors.lastname: Cintra
authors.affiliation: Department of Pathology, Medical School, University of Campinas, Campinas, Brazil.
authors.forename: Konradin
authors.initials: K
authors.lastname: Metze
authors.affiliation: Biophotonics Group, Department of Quantum Electronics, Institute of Physics Gleb Wataghin, University of Campinas, Campinas, Brazil.
authors.forename: Javier
authors.initials: J
authors.lastname: Adur
authors.affiliation: Biophotonics Group, Department of Quantum Electronics, Institute of Physics Gleb Wataghin, University of Campinas, Campinas, Brazil.
authors.forename: Vitor B
authors.initials: VB
authors.lastname: Pelegati
authors.affiliation: Biophotonics Group, Department of Quantum Electronics, Institute of Physics Gleb Wataghin, University of Campinas, Campinas, Brazil; National Institute of Science and Technology on Photonics Applied to Cell Biology, University of Campinas, Campinas, Brazil; Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil.
authors.forename: Hernandes F
authors.initials: HF
authors.lastname: Carvalho
authors.affiliation: Biophotonics Group, Department of Quantum Electronics, Institute of Physics Gleb Wataghin, University of Campinas, Campinas, Brazil; National Institute of Science and Technology on Photonics Applied to Cell Biology, University of Campinas, Campinas, Brazil; Department of Physics, Federal University of Ceara, Fortaleza, Brazil.
authors.forename: Carlos Lenz
authors.initials: CL
authors.lastname: Cesar
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy / Q000473:pathology; D001707:Biopsy, Needle; D003094:Collagen / Q000648:ultrastructure*; D004547:Elastic Tissue / Q000473:pathology / Q000648:ultrastructure*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D036641:Microscopy, Fluorescence, Multiphoton / Q000379:methods; D008875:Middle Aged; D012016:Reference Values; D012494:Sampling Studies; D012594:Scleroderma, Localized / Q000000981:diagnostic imaging* / Q000473:pathology*; D018709:Statistics, Nonparametric; D055815:Young Adult
chemical_list: D003094:Collagen
keywords: 2-photon excited fluorescence; SHG; TPEF; atrophoderma; atrophy; collagen fibers; elastic fibers; idiopathic atrophoderma of Pasini and Pierini; morphometry; pathology; scleroderma; second harmonic generation