Generalized idiopathic atrophodema of Pasini and Pierini misdiagnosed as relapse of disease in a patient with borderline tuberculoid leprosy

Idiopathic atrophoderma of Pasini and Pierini (APP) is a rare condition which is characterized by asymptomatic depressed hypopigmented patches with a classic ‘cliff drop’ edge, usually on the back. There are less than 100 cases reported in the literature till date. APP can mimic borderline tuberculoid (BT) leprosy due to its hypopigmented colour and loss of sensation as a result of damage to dermal nerves. We report a 51 years old man with BT leprosy who had already completed 6 months of PB-MDT adult regimen and subsequently developed new hypopigmented and hypoesthetic skin lesions over the trunk and extremities one year after completion of MDT. The lesions were misdiagnosed as relapse of BT leprosy and the patient was restarted MB-MDT. New lesions kept on appearing despite the intake of MDT. Later histopathology revealed the lesions to be atrophoderma.