Letter - Clinical
Extensive unilateral nevus comedonicus with an inflammatory component
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Dermoscopy showed more clearly the agminated keratotic plugs (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The lesions were present at birth, and those in the cervical region were often the site of inflammation and secondary infection, requiring recurrent cycles of oral antibiotic therapy during follow-up and surgical removal of the inflamed portion. The child had age-appropriate neuropsychomotor development, with no complaints related to other systems and no family history of relevant diseases. There was no ocular, neurological or skeletal involvement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Nevus comedonicus is a rare type of epidermal nevus, characterized by a developmental change affecting the pilosebaceous unit. The most frequently affected regions are the face, cervical region, and trunk. It affects both sexes equally, can be congenital, and, in most cases, appears in children before the age of ten.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It arouses interest due to the scarcity of cases reported in the literature and the diverse clinical presentations, whether as isolated lesions or extensive cases.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The first report of nevus comedonicus was presented in 1875 by Kofmann, and a little over 200 cases have been reported in the literature since then.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Some authors divide nevi comedonicus into two groups: the non-inflammatory type, consisting of asymptomatic comedonal lesions, with purely aesthetic consequences, and the inflammatory one, which is rarer, more exuberant, with inflammatory cysts and recurrent infections, as the case described here.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnosis of nevus comedonicus is usually a clinical one and may be aided by dermoscopy, especially to differentiate it from other epidermal nevi, such as nevus sebaceous.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Histopathology shows dilated and elongated follicular infundibula, with basophilic lamellar corneal content.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This rare hamartomatous condition may be associated with genetic syndromes affecting other systems, and it is important to investigate skeletal, ocular, and central nervous system alterations, which, if present, constitute the nevus comedonicus syndrome.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Despite the extent of the lesions in the patient described in the present report, along the lines of Blaschko, which suggested a mosaic pattern, no associated systemic changes were identified.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The treatment can be topical with the use of emollients, corticosteroids in inflammatory lesions, and keratolytic agents. The use of topical tretinoin has been reported, but there is limited data regarding its efficacy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The use of oral isotretinoin has been shown to be ineffective in most patients; however, it may be considered an option in disseminated cases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There have also been some random reports on the use of laser treatment with partial response.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Surgery is an excellent option in localized lesions. Although the lesions were extensive in the case described here, affecting the right side of the body, only those located on the cervical region showed inflammation and infection, which prompted surgical approach in this symptomatic and restricted area, with good response.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Gessica Ramos Barroso Diniz: Collection of data; drafting and editing of the manuscript or critical review of relevant intellectual content; approval of the final version to be submitted.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Flávia Vasques Bittencourt: drafting and editing of the manuscript and critical review of relevant intellectual content; approval of the final version to be submitted.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-12-29" "fechaAceptado" => "2021-01-18" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1698 "Ancho" => 2925 "Tamanyo" => 367478 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Plaques covered by clusters of comedones, with a small erythematous area and formation of cysts on the right lateral cervical region. (B) Same lesion with worsening of the inflammatory condition.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1746 "Ancho" => 1675 "Tamanyo" => 152004 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Linear lesion formed by a cluster of comedones following Blaschko's lines on the right lower limb.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2446 "Ancho" => 1675 "Tamanyo" => 425122 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy: dilated follicular openings forming groups of keratinous plugs.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy on nevus comedonicus: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 43 | 10 | 53 |
| 2024 October | 261 | 83 | 344 |
| 2024 September | 376 | 115 | 491 |
| 2024 August | 418 | 148 | 566 |
| 2024 July | 390 | 122 | 512 |
| 2024 June | 228 | 89 | 317 |
| 2024 May | 231 | 76 | 307 |
| 2024 April | 247 | 101 | 348 |
| 2024 March | 268 | 73 | 341 |
| 2024 February | 233 | 99 | 332 |
| 2024 January | 276 | 64 | 340 |
| 2023 December | 393 | 71 | 464 |
| 2023 November | 581 | 119 | 700 |
| 2023 October | 424 | 88 | 512 |
| 2023 September | 413 | 85 | 498 |
| 2023 August | 3120 | 58 | 3178 |
| 2023 July | 429 | 34 | 463 |
| 2023 June | 412 | 53 | 465 |
| 2023 May | 470 | 29 | 499 |
| 2023 April | 240 | 27 | 267 |
| 2023 March | 288 | 57 | 345 |
| 2023 February | 209 | 60 | 269 |
| 2023 January | 266 | 74 | 340 |
| 2022 December | 121 | 37 | 158 |
| 2022 November | 61 | 50 | 111 |
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