Combined nevi are melanocytic lesions composed of two or more distinct types of melanocytic populations within the same lesion. Different types of combined nevi may form bizarrely shaped, multicolored skin lesions, making them one of the greatest melanoma mimickers. We report a 48-year-old female patient with suspicious skin lesion in the left lumbar region. Clinically, there was an oval, slightly asymmetrical lesion measuring 6 x 4 mm, showing multiple colors and shades of brown and black. A dermoscopic examination revealed a brown-bluish coloration in the right part of the lesion, while a fine pigment network with perifollicular halo was found in the left part of the lesion, suggesting the diagnosis of a combined nevus. Histological examination showed a poorly circumscribed proliferation of dendritic melanocytes in the superficial and deep dermis and proliferation of melanocytes in the dermoepidermal junction. A surgical excision of the tumor was performed, in order to confirm the dermoscopic findings. In conclusion, dermoscopy is useful in differentiating combined nevi from other melanocytic lesions.
CREST syndrome represents a form of scleroderma where the progressive autoimmune reaction is mainly manifested by the main symptoms, which make this acronym: calcinosis cutis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly and teleangiectasia. Among the first affected organs is the skin followed by the excessive fibrosis manifested by the deposition of collagen in dermis. Reactive oxygen species (ROS) theory has been underlined as one of the main pathogenetic mechanisms and triggering factor in development of scleroderma. The present study was aimed at estimating the marker of lipid peroxidation products (MDA) in plasma of patients with CREST syndrome having manifested symptoms of both Raynaud syndrome and positive ANA antibodies. The lipid peroxidation (MDA) level was significantly higher in the patients who had CREST syndrome and Raynaud syndrome for less than 10 years compared to the patients suffering from Raynoud syndrome for more than 10 years (p<0.05). Both groups were found to have a significant MDA level increase (p<0.001) compared to the control healthy subjects. In conclusion, the relationship between lipid peroxidation (MDA level) and Raynaud syndrome appearance may emphasize the role of ROS produced by the ischemia-reperfusion injury as an early pathogenetic mechanism in CREST scleroderma syndrome.
Verrucous epidermal nevi are noninflammatory, congenital, cutaneous hamartomas composed of keratinocytes, abnormal clone(s) of cells that reflect genetic mosaicism arising from different somatic mutations. Some of these mutations are well recognized, but some are still unidentified. Molecular techniques are used for identification and classification of molecular causes of certain epidermal nevi, whereas all verrucous epidermal nevi are divided into epidermolytic and non-epidermolytic types. They are typically present at birth, but may appear during childhood, even later. Their prevalence in adults ranges from 0.1 to 0.5%, equally affecting both sexes, and about 1 in 1000 newborns.
Warty, brown papules without inflammation distinguish verrucous nevi from other epidermal nevi, while presence at birth and persistance distinguish verrucous epidermal nevi from linear viral warts. Epidermolytic and non-epidermolytic verrucous epidermal nevi are almost always hard to distinguish, except by histology. As a rule, verrucous epidermal nevi are asymptomatic, they have a benign course, except occasionally, and therapy is mostly used for cosmetic reasons. Simple excision is usually the treatment of choice. Topical agents are rarely curative, as well as surgery which is associated with relapses, unless both epidermis and the underlying dermis are removed or destroyed at the same time.
We present a case of an otherwise healthy 21-year-old female patient, who presented with a solitary congenital verrucous cauliflower-like lesion in the right zygomatic region of the face. The lesion was present from birth. Due to its gradual growth during years, the lesion became a great esthetic and functional problem for this young patient. There was no family history of similar or any other tumorous skin lesions in the family. On examination, the patient had a solitar unilateral, well defined yellowish cauliflower-like verrucous lesion confined to the right malar side of the face. The lesion was distributed along the lines of Blaschko extending horizontally, from its wider 1.5 cm cauliflower-like part on the right zygomatic region, towards its tail-like 0.5 cm thick end on the preauricular region, in approximately 3 cm long tail-like manner without crossing the midline. Since the patient refused biopsy, no exact differentiation between epidermolytic and non-epidermolytic nevi was possible. The diagnosis of verrucous epidermal nevus was based on history and clinical presentation, as a diagnosis of exclusion. Due to the fact that patients with epidermolytic verrucous epidermal nevi are at risk of parenting a child with bullous ichthyosiform erythroderma, the patient was counseled on this risk, and on the possibility of first-trimester antenatal diagnosis. The lesion was successfully treated by radio-wave surgery.
Systemic scleroderma (SSc) is a multisystem disease with microvascular abnormalities, autoimmune disorders, excessive collagen production and deposition, and fibrosis of the skin and internal organs. According to the simplest, though incomplete classification, there are two forms of SSc: diffuse and limited (formerly acrosclerosis). CREST syndrome is a subtype of limited SSc, characterized by: calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia. We present a patient with all the features of the CREST syndrome, which appeared at the age of 43 and lasted for 23 years. The patient presented with a gradual development of symptoms during the first ten years, from Raynaud’s phenomenon, skin sclerosis, calcinosis, telangiectasia, and esophageal dysmotility. The diagnosis was based on clinical findings and relevant diagnostic procedures. The article presents a literature review on the epidemiology, etiology, pathophysiology, clinical manifestations, various attempts at classification, diagnostic criteria, and therapeutic modalities.
When classifying systemic scleroderma into two main types — diffuse and limited, with CREST syndrome as a variant of the latter, it should be pointed out that both types represent clinical forms of systemic sclerosis, share similar visceral involvement, laboratory abnormalities and course which is variable, as was the case in our patient.
Azithromycin-Induced Longitudinal Melanonychia in a Child-a Case Report
Andrija Jović, Danica Tiodorović, Danijela Popović, Hristina Kocić, Zorana Zlatanović, Milan Kostić and Giovanni Damiani
Melanonychia refers to a brown or black coloration of the nail plate caused by numerous factors. Regarding the arrangement of pigmentation, we can differentiate between total melanonychia, when pigmentation involves the whole nail plate, or transverse or longitudinal melanonychia, when pigmentation involves the nail in a form of transverse or longitudinal band of pigmentation, respectively. Since longitudinal melanonychia can be a sign of numerous benign and malignant lesions, it often poses a diagnostic challenge for a dermatologist. Herein, we report a case of a 13-year-old girl who developed longitudinal melanonychia on multiple nails after receiving a therapy with azithromycin.