Annular lipoatrophy of the ankle (ALA) is a rare acquired lipoatrophic panniculitis first reported in 1953 by Ferreira-Marques by the name lipoatrophia annularis 1 and then described by Winkelmann as connective tissue panniculitis (CTP), 2 but it would appear that ALA is a more localized form of CTP. 3 It mainly affects children who are otherwise healthy but may present with autoimmune diseases 3-5 and has a stereotyped presentation, starting with inflammatory nodules or plaques around the ankles which progress into circumferential subcutaneous atrophy within a few months. There is no consensus on treatment, and long-term outcomes are poorly documented. We present four new cases of childhood ALA, including a patient with an extended follow-up of more than 10 years. | C A S E REP ORTSFour children (two boys and two girls), aged between 5 and 9 years, were diagnosed with ALA. All were otherwise healthy. Their characteristics are presented in Table 1. ALA has a classic history starting with inflammatory nodules or plaques around the ankles and calves evolving over months to subcutaneous atrophy. Some had triggering events, such as Patient 1 (Figure 1) who reported the appearance of lesions after wearing a new pair of high-top shoes that may have caused local trauma. All had a classic history of ALA except for Patient 2, who reported no initial inflammatory stage. Only, Patient 1 reported initial debilitating symptoms (severe cramps and myalgia).The lesions were located on the lower extremities for all patients except for Patient 3 (Figure 2), who had mild lesions on the buttocks.