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 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 13  |  Issue : 1  |  Page : 75-76

Nevus comedonicus at a rare site


Department of Dermatology, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India

Date of Web Publication10-Sep-2018

Correspondence Address:
Uddhao S Zambare
Department of Dermatology, OPD No 14, 2nd Floor, OPD Building, TNMC and BYL Nair Charitable Hospital, Mumbai Central, Mumbai - 400 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_46_17

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How to cite this article:
Zambare US, Shriramwar VS, Tambe SA, Nayak CS. Nevus comedonicus at a rare site. J Datta Meghe Inst Med Sci Univ 2018;13:75-6

How to cite this URL:
Zambare US, Shriramwar VS, Tambe SA, Nayak CS. Nevus comedonicus at a rare site. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2019 Jun 26];13:75-6. Available from: http://www.journaldmims.com/text.asp?2018/13/1/75/240898



Sir,

Nevus comedonicus (NC) is a type of adnexal hamartoma with abnormal differentiation of the epithelial portion or epidermal nevus involving the hair follicle or appendageal nevus of sweat duct.[1] Here, we present a case of a 21-year-old female with multiple dark-colored lesions on left calf.

A 21-year-old female presented with multiple dark-colored lesions on the left calf region since birth associated with occasional pus discharge. There was no history of similar complaint in other family members. Cutaneous examination revealed multiple grouped pits containing black keratin plugs on the left calf and popliteal fossa [Figure 1]a and [Figure 1]b. There were no ocular, skeletal and central nervous abnormalities. A clinical diagnosis of NC was considered. Skin biopsy was done which on histopathological examination showed epidermal invagination filled with keratin material with hyperkeratotic stratum corneum in church spire pattern with keratin pearls with focal acanthotic epidermis with mild lymphocytic infiltrate suggesting the diagnosis of NC [Figure 2].
Figure 1: (a and b) Multiple grouped pits containing black keratin plugs on the left calf and popliteal fossa

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Figure 2: Histopathology (H and E, ×100). Epidermal invagination filled with keratin material with hyperkeratotic stratum corneum in church spire pattern with keratin pearls with focal acanthotic epidermis with mild lymphocytic infiltrate

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NC is a misnomer as there are no comedones. NC was first described by Kofmann in 1895. This condition has been termed comedone nevus, nevus acneiformis unilateralis, and nevus zoniforme. The commonest site is face, followed by trunk, upper arm, palms, and soles. Rare sites include leg and glans penis. Lesions usually manifest at birth (50%) or by the age of 10 years, mostly unilateral but may assume blaschkoid or linear distribution.[1]

Clinical presentation consists of multiple grouped pits with blackish keratin plug resembling open comedones.[1]

NC may be isolated or may be associated with NC syndrome which consists of ipsilateral cataract, skeletal abnormalities, CNS abnormalities (mental retardation and seizures), and extensive nevus flammeus.[2] Although NC is thought to be a benign condition, squamous cell carcinoma has been reported in one case of NC.[3] NC occurs by mosaicism of mutation of fibroblast growth receptor factor-2.[1]

Characteristic histological finding includes deep, wide invagination of acanthotic epidermis filled with concentric lamella of keratin. They may be the dilated hair follicles, as hair shaft may be seen at the lower portion of invagination and rudimentary sebaceous gland may open into them. Interfollicular epidermis may be normal and may show epidermolytic hyperkeratosis.[1]

Treatment of NC is difficult. Various treatment modalities have been described in the literature which includes keratolytic drugs such as topical tretinoin (0.1%) gel, tazarotene, calcipotriol, ammonium lactate while systemic isotretinoin, dermabrasion, and surgical extraction are other modalities.[4] CO2 laser and Erbium yttrium aluminum garnet laser are the newer modalities of treatment of NC.[5],[6]

Our case highlights the occurrence of NC at a rare site such as leg.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lefkowitz A, Schwartz RA, Lamdert WC. Nevus comedonicus. Dermatology 1999;199:204-7.  Back to cited text no. 1
    
2.
Patrizi A, Neri I, Fiorentini C, Marzaduri S. Nevus comedonicus syndrome: A new pediatric case. Pediatr Dermatol 1998;15:304-6.  Back to cited text no. 2
    
3.
Walling HW, Swick BL. Squamous cell carcinoma arising in nevus comedonicus. Dermatol Surg 2009;35:144-6.  Back to cited text no. 3
    
4.
Deliduka SB, Kwong PC. Treatment of nevus comedonicus with topical tazarotene and calcipotriene. J Drugs Dermatol 2004;3:674-6.  Back to cited text no. 4
    
5.
Sardana K, Garg VK. Successful treatment of NC with ultrapulse CO2 laser. Indian J Dermatol Venereol Leprol 2009;75:534-5.  Back to cited text no. 5
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6.
Caers SJ, Van der Geer S, Beverdam EG, Krekels GA, Ostertag JU. Successful treatment of nevus comedonicus with the use of the Erbium Yag laser. J Eur Acad Dermatol Venereol 2008;22:375-7.  Back to cited text no. 6
    


    Figures

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