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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 20  |  Issue : 3  |  Page : 240-242

Eruptive collagenoma: A rare entity in pediatric age


1 Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
2 Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India

Date of Web Publication28-Jun-2019

Correspondence Address:
Dr. Sonia Jain
Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha - 442 102, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_137_18

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  Abstract 


Eruptive collagenoma is a rare acquired connective tissue nevus predominantly composed of collagen, with elusive incidence and etiopathogenesis. Many cases are reported in young adults, but there is a dearth of literature in children. Herein, we report a rare case of eruptive collagenoma in a 5-year-old child who presented with multiple asymptomatic papules, plaques, and nodules over the back and face with no systemic involvement. There was no positive family history or history of consanguineous marriage, and diagnosis was confirmed histopathologically. We report this case due to its rarity in Indian literature in pediatric population with facial involvement.

Keywords: Connective tissue nevi, eruptive collagenoma, pediatric age


How to cite this article:
Sonkusale P, Jain S, Deshmukh A. Eruptive collagenoma: A rare entity in pediatric age. Indian J Paediatr Dermatol 2019;20:240-2

How to cite this URL:
Sonkusale P, Jain S, Deshmukh A. Eruptive collagenoma: A rare entity in pediatric age. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 Oct 16];20:240-2. Available from: http://www.ijpd.in/text.asp?2019/20/3/240/261872




  Introduction Top


Eruptive collagenoma was first reported and named by Colomb in 1955.[1] Connective tissue nevi are hamartomas characterized by abnormal proliferation both in the amount and structure of extracellular dermal tissue matrix, specifically collagen and elastin and/or proteoglycans.[2] It presents with an abrupt onset of multiple fibrous, skin-colored or brownish papules and nodules that coalesce to form the plaques typically over the trunk, frequently in young adults. Its incidence and pathogenesis are elusive and it has no family history or systemic involvement.[3]


  Case Report Top


A 5-year-old girl was brought to the dermatology department with a history of multiple, asymptomatic, raised progressive skin lesions over the back and face for 3½ years. There was no history of developmental delay, anomalies, epilepsy, mental retardation, or neurocutaneous stigmata. The child was born of a non-consanguineous union, and family history was not contributory. No systemic abnormalities were detected.

Cutaneous examination showed multiple discrete-to-confluent papules and plaques of size ranging from 0.2 cm × 0.5 cm to 2 cm × 3 cm to 3 cm × 5 cm over the right cheek, forehead, left eye [Figure 1] and [Figure 2], back, and lumbosacral area [Figure 3]. Firm, nontender nodules ranging from size of 0.5 cm × 1 cm to 1.5 cm × 1.5 cm were found on the back and lumbosacral area. We evaluated the patient considering the differential diagnosis of connective tissue nevus, neurofibromatosis, tuberous sclerosis (TS), or histoid leprosy. No hypopigmented macules and ungual and periungual fibromas suggestive of TS were present. There were no other skin lesions or epileptic episodes in favor of neurofibromatosis. Slit-skin smear for acid-fast bacilli was also negative. Systemic examination and all other routine investigations were normal. Histopathology revealed thickened reticular dermis with haphazardly arranged thickened collagen bundles suggestive of collagen nevus on hematoxylin and eosin stain [Figure 4]. Special stains using Masson's trichrome showed an increased collagen tissue in the dermis [Figure 5], whereas Orcein stain showed decreased elastic fiber in the dermis which further strengthened the diagnosis of eruptive collagenoma [Figure 6].
Figure 1: Few brown-colored plaques present on the right side of the forehead

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Figure 2: Multiple brown-colored nontender papules present over the left periorbital region

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Figure 3: Multiple skin-coloured papules and plaques present over the back and lumbosacral area

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Figure 4: Randomly arranged thick bundles of collagen within the dermis (H and E, ×100)

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Figure 5: Haphazardly arranged thick collagen bundle in the dermis (Masson's trichrome, ×100)

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Figure 6: Decrease in elastic fiber in the dermis (Orcein, ×100)

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  Discussion Top


Uitto et al. had classified collagenoma based on the pattern of distribution as localized or generalized and on the mode of inheritance as acquired or inherited.[4] Inherited type includes familial cutaneous collagenomas and shagreen patches of TS. Familial collagenoma presents in the second and third decades of life characterized by numerous, symmetrical lesions over the trunk and proximal arms with a positive family history and systemic involvement.[4] Acquired type includes eruptive and isolated collagenomas which present with sudden asymptomatic, firm, skin-colored papules and nodules of various sizes on the trunk and upper extremities, in the first two decades of life.

Uitto et al.[5] showed that collagenoma mainly consists of type I collagen with reduced production of collagenase. It should be differentiated from nevus anelasticus and papular elastorrhexis.[6] Nevus anelasticus is an acquired perifollicular papule with lack of elastic tissue. Papular elastorrhexis occurs in the second decade as multiple asymptomatic papules over the trunk and extremities with no perifollicular predilection. Both on histology show focal area of decreased and fragmented elastic fibers. Recently, CD34+ staining of the spindle cells and the blood vessels has been described for connective tissue nevi,[7] which helps to clarify difficult cases and may be useful in future. This was not done in our case. No specific treatment is reported.

Our patient was diagnosed as eruptive collagenoma based on multiple skin lesions (onset at the age of 1½ years), histopathology, absence of family history, and systemic involvement.

Only two cases have been reported with the early onset of presentation- by Yahya and Rafindadi in a 2-year-old Nigerian girl[8] and by Lee et al. with onset at 5 years.[9] Only three cases in literature reported facial involvement.[8],[10],[11] Ours is the second case report after Barad et al.[10] to report eruptive collagenoma in a child in Indian literature.


  Conclusion Top


There are few published reports on eruptive collagenoma in pediatric population in Indian literature. This rare entity can be diagnosed clinically and confirmed by histopathology. The publication of new cases will improve case detection. Publication will not alleviate the worries of the parents.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zhao C, Ma W, Wang Y, Sun Q. Female with eruptive collagenoma clustered in the left lateral aspect of the abdomen. J Dermatol 2010;37:843-5.  Back to cited text no. 1
    
2.
Uitto J, Santa Cruz DJ, Eisen AZ. Connective tissue nevi of the skin. Clinical, genetic, and histopathologic classification of hamartomas of the collagen, elastin, and proteoglycan type. J Am Acad Dermatol 1980;3:441-61.  Back to cited text no. 2
    
3.
Xiao M, Yang L, Dong L, Wang Y, Sun X, Tao J, et al. Three cases of eruptive collagenoma and a literature review, 1970-2012. Eur J Dermatol 2014;24:384-5.  Back to cited text no. 3
    
4.
Uitto J, Santa-Cruz DJ, Eisen AZ. Familial cutaneous collagenoma: Genetic studies on a family. Br J Dermatol 1979;101:185-95.  Back to cited text no. 4
    
5.
Uitto J, Bauer EA, Santa Cruz DJ, Holtmann B, Eisen AZ. Decreased collagenase production by regional fibroblasts cultured from skin of a patient with connective tissue nevi of the collagen type. J Invest Dermatol 1982;78:136-40.  Back to cited text no. 5
    
6.
Ryder HF, Antaya RJ. Nevus anelasticus, popular elastorrhexis, and eruptive collagenoma: Clinically similar entities with facial absence of elastic fibres in childhood. Pediatr Dermatol 2005;53:S150-3.  Back to cited text no. 6
    
7.
McCuaig CC, Vera C, Kokta V, Marcoux D, Hatami A, Thuraisingam T, et al. Connective tissue nevi in children: Institutional experience and review. J Am Acad Dermatol 2012;67:890-7.  Back to cited text no. 7
    
8.
Yahya H, Rafindadi AH. Eruptive collagenoma in a Nigerian girl. Int J Dermatol 2006;45:1344-6.  Back to cited text no. 8
    
9.
Lee MW, Choi JH, Sung KJ, Moon KC, Koh JK. A case of eruptive collagenoma. Pediatr Dermatol 2002;19:565-7.  Back to cited text no. 9
    
10.
Barad P, Fernandes J, Shukla P. Eruptive collagenoma: A rarely reported entity in Indian literature. Indian J Dermatol 2015;60:104.  Back to cited text no. 10
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11.
Mukhi SV, Kumar P, Yuvarajkumar D, Raghuveer CV. Eruptive collagenoma. Indian J Dermatol Venereol Leprol 2002;68:98-9.  Back to cited text no. 11
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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Abstract
Introduction
Case Report
Discussion
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