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LETTER TO EDITOR
Year : 2019  |  Volume : 20  |  Issue : 4  |  Page : 345-347

Occurrence of filiform wart over nevus sebaceous: A report of two cases of locus minoris resistentiae


Department of Dermatology, Venereology and Leprosy, Government Medical College, Nagpur, Maharashtra, India

Date of Web Publication30-Sep-2019

Correspondence Address:
Dr Bhagyashree Babanrao Supekar
Department of Dermatology, Venereology and Leprosy, Government Medical College, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_59_19

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How to cite this article:
Ghanate TD, Roge RP, Supekar BB, Wankhade VH, Singh R P. Occurrence of filiform wart over nevus sebaceous: A report of two cases of locus minoris resistentiae. Indian J Paediatr Dermatol 2019;20:345-7

How to cite this URL:
Ghanate TD, Roge RP, Supekar BB, Wankhade VH, Singh R P. Occurrence of filiform wart over nevus sebaceous: A report of two cases of locus minoris resistentiae. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 Nov 13];20:345-7. Available from: http://www.ijpd.in/text.asp?2019/20/4/345/268399



Sir,

Locus minoris resistentiae (LMR) is a site that offers lesser resistance or increased vulnerability than the rest of the body to the onset of disease. Trauma, irradiation, healed herpes scars, or chronic lymph stasis commonly act as LMR, leading to localization of numerous inflammatory and neoplastic conditions.[1] Areas of cutaneous mosaicism act as congenital LMR. The occurrence of an infectious condition such as verrucae over areas of cutaneous mosaicism is rare.

Our case, a 10-year-old female child, presented with an asymptomatic single orange-brown raised lesion over the scalp since birth. Her mother noticed a new growth with finger-like projections over existing old lesions since 2 months. There was a solitary well-defined verrucous hairless orange-brown plaque with filiform growth present over the scalp [Figure 1]. Biopsy from orange-brown plaque revealed orthokeratosis, acanthosis, and defective hair follicle with conglomeration of the sebaceous gland, suggestive of nevus sebaceous [Figure 2]a, [Figure 2]b,[Figure 2]c, [Figure 2]d. Biopsy of the filiform lesion revealed hyperkeratosis, parakeratosis, acanthosis, marked papillomatosis, spongiosis with fibronuclear core, and koilocytic changes, suggestive of filiform wart. On the basis of clinico-histopathological findings, a diagnosis of filiform wart over nevus sebaceous was confirmed.
Figure 1: Solitary well-defined verrucous hairless orange-brown plaque with filiform growth over the frontotemporal part of the scalp (case 1)

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Figure 2: (a-d) Case 1 – Histopathology from orange-brown plaque revealed orthokeratosis, acanthosis, and defective hair follicle with conglomeration of the sebaceous gland, suggestive of nevus sebaceous ([a and b] H and E, ×4, ×10). Biopsy of the filiform lesion revealed hyperkeratosis, parakeratosis, acanthosis, marked papillomatosis with fibronuclear core, and koilocytic changes, suggestive of filiform wart ([c and d] H and E, ×4, ×10)

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Our second case, a 6-year-old female child, presented with a yellow-brown lesion on her scalp since birth. Her mother noticed a new growth with finger-like projections over the yellowish-brown plaque since 3 months. A well-demarcated hairless yellowish-brown plaque with a filiform growth in the center was present over the scalp [Figure 3]a and [Figure 3]b. A clinical diagnosis of nevus sebaceous with filiform wart was confirmed on histopathology [Figure 4]a, [Figure 4]b, [Figure 4]c, [Figure 4]d. Financial constraints restricted further typing and detection of human papillomavirus (HPV), and verrucae were treated with electrocautery in both the cases.
Figure 3: (a and b) Well-demarcated hairless yellowish-brown plaque with a filiform growth over the parietal region of the scalp. (a) Posttreatment image of case 2 (b)

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Figure 4: (a and d) Case 2 – Histopathology from hairless brown plaque suggestive of nevus sebaceous ([a and b] H and E, ×4, ×10). Histopathology from filiform lesion, suggestive of filiform wart ([c and d] H and E, ×4, ×10)

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LMR can be congenital or acquired. Areas of cutaneous mosaicism such as epidermal nevi, lichen striatus, congenital hemangioma, giant congenital melanocytic nevus, linear porokeratosis, and CHILD syndrome act as congenital LMR.[2] Nevus sebaceous of Jadassohn is a benign hamartoma with epidermal, follicular, and apocrine elements, which is postulated to develop due to genetic mosaicism in stem cells that expand in the  Lines of Blaschko More Details. Various skin disorders including inflammatory dermatoses, adnexal disorders, and neoplasms have been reported to occur superimposed on epidermal or sebaceous nevus.[3]

Baykal et al. reported that trichoblastoma and basal cell carcinoma (BCC) associated with nevus sebaceous were the most benign and malignant tumors, respectively.[4] Cribier et al. reported that the most common benign and malignant tumors were syringocystadenoma papilliferum and BCC, respectively. They also reported 14 cases of occurrence of verrucae over nevus sebaceous including 2 children and 13 adults.[5] The occurrence of an infectious lesion over an area of cutaneous mosaicism is a rare example of LMR. Carlson et al. detected HPV DNA in 82% of nevus sebaceous. Whether HPV represents a commensal infection caused by localized cutaneous predisposition or is an essential factor in pathogenesis of nevus sebaceous is unknown.[5] Ranugha et al. reported three cases of occurrence of verruca over linear verrucous epidermal nevus.[3] Less than 20 case reports of occurrence of verruca over nevus sebaceous have been reported worldwide [Table 1].
Table 1: Literature review of occurrence of verruca over nevus sebaceous

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The available literature survey did not show any such reports from India. It may be noted that while this may be a relatively common occurrence in Indian scenario owing to the vast number of cases, there is a lack of literature reporting the same. This is reported to emphasize that any growth over nevus sebaceous should be confirmed histopathologically due to rarity of this association.

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.
Ruocco V, Ruocco E, Piccolo V, Brunetti G, Guerrera LP, Wolf R. The immunocompromised district in dermatology: A unifying pathogenic view of the regional immune dysregulation. Clin Dermatol 2014;32:569-76.  Back to cited text no. 1
    
2.
Al-Rohil RN, Leung D, Carlson JA. Congenital vulnerability of cutaneous segments arising from skin mosaicism: A genetic basis for locus minoris resistentiae. Clin Dermatol 2014;32:577-91.  Back to cited text no. 2
    
3.
Ranugha PS, Betkerur JB, Veeranna S, Basavaraj V. Appearance of verruca over linear verrucous epidermal nevus – An example of locus minoris resistentiae: A report of three cases. Indian Dermatol Online J 2018;9:334-7.  Back to cited text no. 3
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4.
Baykal C, Buyukbabani N, Yazganoglu KD, Saglik E. Tumors associated with nevus sebaceous. J Dtsch Dermatol Ges 2006;4:28-31.  Back to cited text no. 4
    
5.
Carlson JA, Cribier B, Nuovo G, Rohwedder A. Epidermodysplasia verruciformis-associated and genital-mucosal high-risk human papillomavirus DNA are prevalent in nevus sebaceus of Jadassohn. J Am Acad Dermatol 2008;59:279-94.  Back to cited text no. 5
    
6.
Cicek AF, Aykan A, Yapici A, Gamsizkan M, Ozturk S, Demiriz M. Nevus sebaceus with basal cell carcinoma, poroma, and verruca vulgaris. Indian J Pathol Microbiol 2015;58:534-6.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceus: A study of 596 cases. J Am Acad Dermatol 2000;42:263-8.  Back to cited text no. 7
    
8.
Richey PM, Jamison MO, Radfar AA, DeKlotz MC. New growth over a nevus sebaceous in a 10-year-old girl. J Am Acad Dermatol 2016;74:AB214.  Back to cited text no. 8
    


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