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CASE REPORT
Year : 2020  |  Volume : 21  |  Issue : 3  |  Page : 232-234

Dermoscopy of nevus comedonicus: A case series


1 Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Dermatology, Venereology and Leprology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, India

Date of Submission25-Feb-2020
Date of Decision06-Mar-2020
Date of Acceptance23-Mar-2020
Date of Web Publication30-Jun-2020

Correspondence Address:
Dr. Payal Chauhan
Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_29_20

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  Abstract 


Nevus comedonicus (NC) is an uncommon condition which belongs to the spectrum of the epidermal nevi syndrome. Dermoscopy is a non-invasive tool which can help to rule out other differential diagnoses, making it especially valuable in pediatric cases. We present three children with NC and describe their dermoscopic findings.

Keywords: Dermoscopy, epidermal nevus, nevus comedonicus


How to cite this article:
Chauhan P, Meena D, Sharma S. Dermoscopy of nevus comedonicus: A case series. Indian J Paediatr Dermatol 2020;21:232-4

How to cite this URL:
Chauhan P, Meena D, Sharma S. Dermoscopy of nevus comedonicus: A case series. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 Jul 10];21:232-4. Available from: http://www.ijpd.in/text.asp?2020/21/3/232/288498




  Introduction Top


Nevus comedonicus (NC) is a rare type of epidermal nevus that clinically presents as grouped dilated follicular openings with keratotic plugs, an appearance similar to comedones. Lesions usually present at birth, though sporadic cases of development later in life have been reported.[1] Here, we describe three cases of this disorder along with the utility of dermoscopic examination in the cases.


  Case Reports Top


Case 1

A 6-year-old male child presented with blackish plugged lesions over the lateral aspect of the right thigh. It started as a solitary lesion on the right thigh at birth, gradually increasing in size proportionate to his body growth. History of chronic inflammation and suppuration was present which healed with scarring. On cutaneous examination, the lesion comprised of multiple, comedo-like openings with dark keratin plugs linearly arranged over the lateral aspect of the right thigh. Few inflammatory nodules, areas of hypertrophic and atrophic scarring were also noted [Figure 1]. There were no associated ocular, neurologic, or skeletal abnormalities. Dermoscopy (DermLite II hybrid m; 3Gen; polarized mode, ×10) revealed multiple, sharply demarcated keratinous plugs surrounded by dark-to-light brown structure-less homogeneous circular areas [Figure 2]. The diagnosis of nevus comedonicus was made on the basis of the clinical and dermoscopic pictures.
Figure 1: Multiple dilated follicular openings resembling comedones with dark keratin plugs linearly arranged over the lateral aspect of the right thigh. Few inflammatory nodules, hypertrophic and atrophic scars also seen

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Figure 2: Dermoscopic examination showing multiple sharply demarcated keratinous plugs (red circles) surrounded by dark-to-light brown structure-less homogeneous circular areas (black arrow)

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Case 2

A 16-year-old male child presented with complaints of multiple, dark, and plugged lesions over the trunk. On clinical examination, dilated follicular opening with keratotic plugs and surrounding hyperpigmentation were seen over left lateral aspect of the trunk in a blaschkoid pattern. An inflammatory red plaque was also seen [Figure 3]. Dermoscopy (DermLite II hybrid m; 3Gen; polarized mode, ×10) revealed brownish structure-less homogeneous circular areas with multiple, overlying, sharply demarcated keratinous plugs [Figure 4]. A final diagnosis of nevus comedonicus was made after clinico-dermoscopic correlation.
Figure 3: Dilated follicular opening with keratotic plugs and surrounding hyperpigmentation over the left lateral aspect of the trunk in a blaschkoid pattern

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Figure 4: Brownish structure-less homogeneous circular areas (black arrow) with multiple keratinous plugs (red circle)

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Case 3

A 14-year-old female presented with hyperpigmented lesions over her face which appeared 4 years back and was progressing gradually since then. On examination, closely arranged keratotic plugs were present in a linear pattern over the right preauricular area [Figure 5]. Dermoscopic examination (DermLite II hybrid m; 3Gen; polarized mode, ×10) was done which revealed multiple keratotic plugs with surrounding round-to-oval, light-to-dark brown circular areas [Figure 6]. A final diagnosis of NC was made.
Figure 5: Closely arranged keratotic plugs in a linear pattern over the right preauricular area

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Figure 6: Multiple keratotic plugs (red circles) with surrounding round-to-oval, light-to-dark brown circular areas (black arrows)

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  Discussion Top


NC is a rare skin disorder belonging to the spectrum of the epidermal nevi syndrome. Usually involving the face and neck area, it can present in unilateral, bilateral, linear, interrupted, segmental, or blaschkoid pattern. In around half of the cases, it manifests shortly after birth with the most of the cases presenting before the age of 10. Two types of NC have been identified; the first is nonpyogenic NC with acne-like characteristics and a second type characterized by the formation of cysts, papules, pustules, and abscesses in various stages of development. The second type has a tendency to recur with the formation of fistulas and abscesses.[1] NC has been described in association with various extracutaneous manifestations which is termed as “NC syndrome.” Noncutaneous developmental abnormalities include skeletal malformation, eccrine spiradenoma and hidradenoma, bilateral follicular basal cell nevus, alagille syndrome, central nervous system abnormalities, multiple basal cell carcinoma, ipsilateral polysyndactyly and bilateral oligodontia, ipsilateral cataract, and trichilemmal cysts.[1]

The diagnosis of NC is mainly based on the clinical picture, but in uncertain cases, the histopathological picture confirms the diagnosis. Histopathological findings on skin biopsy typically show large, grouped, and dilated follicular ostia filled with keratin but devoid of hair shafts.[1] Dermoscopic examination of the condition can act as a noninvasive, rapid and useful method for the diagnosis of NC based on its distinctive findings. Dermoscopy findings in our cases are in line with those previously reported.[2],[3] Dermoscopic examination can help differentiate NC from comedones of acne, other rare epidermal nevi, such as sebaceous nevus and hair follicle nevus.[2] The dermoscopic finding of various differentials of NC are summarized in [Table 1].
Table 1: Dermoscopic findings of nevus comedonicus and its differentials

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There is a paucity of literature on dermoscopy of this rare disorder, with only a handful of reports. Hereby, we wish to highlight the importance of dermoscopy in the diagnosis of NC, which can help subvert the need of an invasive procedure-like biopsy, in turn, avoiding further trauma to the child and parents.

Aggressive treatment is not required except for aesthetic reasons or in complicated cases. Treatment modalities include surgical excision with tissue expansion, laser therapy (diode laser 1450-nm, ultra pulse CO2, or Erbium: YAG), dermabrasion, topical retinoic acid, and 12% ammonium lactate.[2]

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.
Tchernev G, Ananiev J, Semkova K, Dourmishev LA, Schönlebe J, Wollina U. Nevus comedonicus: An updated review. Dermatol Ther (Heidelb) 2013;3:33-40.  Back to cited text no. 1
    
2.
Kamińska-Winciorek G, Spiewak R. Dermoscopy on nevus comedonicus: A case report and review of the literature. Postepy Dermatol Alergol 2013;30:252-4.  Back to cited text no. 2
    
3.
Vora RV, Kota RS, Sheth NK. Dermoscopy of nevus comedonicus. Indian Dermatol Online J 2017;8:388-9.  Back to cited text no. 3
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    Figures

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

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