|Year : 2019 | Volume
| Issue : 1 | Page : 78-80
Department of Pediatric Dermatology, B J Wadia Hospital for Children, Parel, Mumbai, Maharashtra, India
|Date of Web Publication||14-Dec-2018|
Dr. Resham Vasani
C-1, 22, Karmakshetra, Near Shanmukhananda hall, Sion, Mumbai-37, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vasani R. Meyerson phenomenon. Indian J Paediatr Dermatol 2019;20:78-80
| What is Meyerson Phenomenon?|| |
Meyerson phenomenon is a symmetrical area of erythema and scaling encircling a central lesion which is most commonly a benign melanocytic nevus. It can refer to eczematisation of the central nevic lesion and/or of its periphery. Multiple nevi can be involved separately or simultaneously. It is a rare event, with an unclear pathogenesis with benign nonrecurring course. The other terms for this phenomenon are halo eczema or halo dermatitis or Meyerson nevus.
| Who Discovered Meyerson Phenomenon?|| |
Meyerson described it in 1971 in 2 men having benign melanocytic nevi surrounded by eczema which he thought could be atypical variant of pityriasis rosea. It recurred for many months despite topical steroid treatment leaving behind slight hypopigmentation around the involved nevi which cleared after few months. In 1988, Nicholls and Mason proposed the eponym Meyerson Nevus and this phenomenon was called as Meyerson phenomenon.
| What are the Clinical Features of Halo Dermatitis?|| |
Recent reports have shown no predisposition to specific gender or location. It is usually asymptomatic though pruritus can be present. Association with atopy is not consistent. The dermatitis can last from 2 weeks to many years. It is seen in multiple conditions as mentioned in [Box 1]. It is more commonly seen as an eczematous lesion around a central molluscum and is often called “molluscum eczema” [Figure 1]. It is thought to be one of the inflammatory phenomena that precede the disease resolution, hence, one of the variations of “Beginning of the end” sign. [Figure 2] shows the presence of halo dermatitis around a linear verrucous epidermal nevus. One can differentiate it from the inflammatory verrucous epidermal nevus clinically by the de novo appearance of eczematous changes perilesionally in an otherwise quiescent verrucous epidermal nevus. These changes respond to topical corticosteroids and have a corroborative histopathology.
|Figure 1: (a) An area of eczema surrounding a molluscum on the lower eyelid suggestive of molluscum eczema. (b) Erythema and scaling around a resolving molluscum – a variation of “beginning of the end” sign|
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|Figure 2: Erythema and scaling surrounding linear verrucous epidermal nevus on the chest|
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| What is the Pathogenesis of Meyerson Phenomenon?|| |
Exact pathogenesis is unknown in most cases. The dermatitis is immune mediated with upregulation of intercellular adhesion molecule-1 (ICAM-1) on keratinocytes and dermal endothelial cell surfaces which initiates an autoimmune reaction against the skin melanocytes. CD4+ lymphocytes are found to be the major cellular infiltrate with a reduced proportion of CD8+ cells. In case of a vascular malformation, the hypothesis is that, within the malformation the skin shows abnormal dermal vasculature, and these ectatic vessels possibly cause excessive production of proinflammatory cytokines, promoting the development of eczema.
Certain reported triggers include:
- Ultraviolet radiation–MP has been reported after severe sunburn
- Interferon-α-2B – It causes stimulation of ICAM-1
- Laser therapy for vascular malformations.
| What is the Histopathology of Halo Dermatitis?|| |
- Epidermis – Epidermal spongiosis, vesiculation, lymphocytic exocytosis, acanthosis and parakeratosis
- Dermis – Interstitial lymphohistiocytic inflammatory infiltrate in the superficial dermis in contact with the nevus with presence of eosinophils.
The histological examination has little value in the diagnosis.
| Does Meyerson Phenomenon alter the Dermoscopic Findings of the Underlying Nevus?|| |
Dermoscopy of Meyerson phenomenon reveals spongiotic dermatitis. It however doesn't alter the dermoscopic features of the underlying nevi.
| How is Halo dermatitis different from Allergic Contact Dermatitis?|| |
Eosinophils are demonstrated in the dermal infiltrate of the skin showing Meyerson phenomenon suggesting allergic contact, but the T cells in halo dermatitis do not express receptor for interleukin-2 as is found in allergic contact dermatitis.
| How is Halo Dermatitis different from Halo Nevus?|| |
Sutton's nevus/Halo nevus is a nevus surrounded by hypo or depigmentation [Figure 3]. Halo dermatitis and Halo nevi are opposite ends of the immunological spectrum with CD4+ lymphocytes predominant in halo dermatitis and CD8 lymphocytes predominant in Halo nevi. Absence of regression or depigmentation of the central lesion helps to differentiate halo dermatitis from halo nevi. Though defined as distinct entities, the evolution of a Meyerson nevus to a Sutton nevus has been reported as well as co-existence of Sutton's and Meyerson nevi in the same patient, as well in the same nevus has been reported.,
|Figure 3: A halo of depigmentation surrounding a central nevus suggestive of Sutton nevus or Halo nevus|
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| What is the Treatment?|| |
- It tends to resolve spontaneously in some months without resolution of the nevus. May result in hypopigmentation around the nevus that persists
- Topical steroid can be given in cases of intense inflammation and itching
- Immunosupressive action of sunlight in the form gradual sun exposure has been found to be useful. Hence, narrow-band ultraviolet B may be effective
- Surgical excision of nevus especially if the lesions do not respond to topical corticosteroids.
| What is the clinical significance of Meyerson Phenomenon?|| |
The presence of inflammation in or around a benign lesion can arouse the concern of malignant transformation. Though this is not true in most cases, halo dermatitis has been described as an eczematised response to a melanoma in situ as well as high risk melanoma., Hence, all lesions should be evaluated based on clinical or dermoscopic grounds regardless of the presence or absence of eczema. Halo of eczema cannot be considered a reassuring sign when evaluating melanocytic lesions.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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[Figure 1], [Figure 2], [Figure 3]