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Indian Journal of Dermatology
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E-IJD-CASE REPORT
Year : 2015  |  Volume : 60  |  Issue : 1  |  Page : 105
Nevus comedonicus on scalp: A rare site


1 Department of Dermatology, Sri Dharmasthala Manjunatheshwara, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
2 Department of Pathology, Sri Dharmasthala Manjunatheshwara, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India

Date of Web Publication26-Dec-2014

Correspondence Address:
Naveen N Kikkeri
Department of Dermatology, No 10, Skin OPD, Sri Dharmasthala Manjunatheshwara College Of Medical Sciences and Hospital, Sattur, Dharwad - 580 009, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.147861

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   Abstract 

Nevus comedonicus is rare hamartoma of the pilosebaceous unit. Curiously the scalp is rarely involved. Here we are reporting 33-year-old male presenting with nevus comedonicus arranged linearly on the scalp. There was positive family history of similar lesion on the similar site. This case has been presented for its sheer rarity and atypical site.


Keywords: Nevus comedonicus, scalp, keratin pits


How to cite this article:
Kikkeri NN, Priyanka R, Parshawanath H A. Nevus comedonicus on scalp: A rare site. Indian J Dermatol 2015;60:105

How to cite this URL:
Kikkeri NN, Priyanka R, Parshawanath H A. Nevus comedonicus on scalp: A rare site. Indian J Dermatol [serial online] 2015 [cited 2020 Sep 26];60:105. Available from: http://www.e-ijd.org/text.asp?2015/60/1/105/147861

What was known?
Nevus comedonicus is rare hamartoma of the pilosebaceous unit.



   Introduction Top


Comedo nevus also known as nevus comedonicus is a rare nevus. It is a linear lesion comprising numerous keratin-filled pits, sometimes with acneiform pustules. The commonest site is the face, followed by the neck, trunk and upper arm. Palms, soles and the glans penis, from which pilosebaceous follicles are normally absent, may occasionally be involved. Curiously the scalp is rarely involved. [1]


   Case Report Top


A 33-year-old male patient presented to our department with groups of discrete pits filled with keratin resembling comedones over his scalp. The lesions were present since birth and gradually increasing in size not associated with itching. History of similar lesion was present in his grandparent. There was no history of suppuration, discharge or inflammation on the lesions. There was no history suggestive of involvement of central nervous system, skeletal and ocular involvement. There was no other similar lesion elsewhere in the body.

Cutaneous examination revealed multiple dilated follicular openings filled with black plugs over the scalp arranged linearly. There was normal skin in between the two groups [Figure 1]. Routine hematological examination is within normal limits. A punch biopsy was done from the lesion. Histopathology showed epidermis with deep invagination filled with keratin [Figure 2]. The dermis showed rudimentary appendages.

Based on the clinical characteristics and histopathology findings a diagnosis of nevus comedonicus was made. The patient was started on topical retinoids and currently lost for follow up.
Figure 1: Multiple keratin filled pits present on the scalp with intervening normal skin

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Figure 2: Histopathology showing epidermis with deep invagination filled with keratin; H and E 40x

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   Discussion Top


Naevus comedonicus is a rare hamartoma of the pilosebaceous unit. [2] It was first described by Kofmann in 1895. [3] Comedo naevus on hair-bearing limbs contiguous with lesions involving eccrine ducts on the palms and soles, resembling porokeratotic eccrine ostial and dermal duct nevus, and glans penis, supports a non-appendage-specific epidermal problem causing duct blockage. [1] Clinically, it presents as comedo like dilated pores with keratinaceous plugs in a linear, nevoid, bilateral or zosteriform pattern. The intervening epidermis may appear normal, hyperkeratotic, or slightly hypo- or hyperpigmented. In the inflammatory variant, there will be suppurative cysts and acne like lesions. [1],[2] In our patient, there were two groups of comedo like pores arranged linearly with intervening normal skin. There were no signs of inflammation.

Nevus comedonicus syndrome is the association of nevus comedonicus with non-cutaneous findings such as skeletal defects, cerebral abnormalities, and cataracts. [2] Detailed examination of our patient did not reveal any other abnormalities.

The scalp is very rare site for the naevus comedonicus. There are very few reports of comedo naevus affecting scalp. Ghaninezhad et al.,[4] reported nevus comedonicus on the scalp in a 3-year-old boy. There were no other physical or cutaneous abnormalities in that patient. There was no family history of similar lesions. Sikorski et al., reported another case of nevus comedonicus on the scalp in 16 month old male child, who presented with intermittent "discharge" on the lesion. [5]

Treatment of comedo naevus includes surgical excision with tissue expansion which is more effective in the long term than superficial shaving or dermabrasion. Topical retinoic acid and 12% ammonium lactate may be used. Tacalcitol and tazarotene 0.05% with calcipotriene 0.005% daily have also been used effectively. [1]

In conclusion, we are presenting a case of linear nevus comedonicus on scalp. This rare case has been presented for its classical presentation and affection of rare site.

 
   References Top

1.
Moss C, Shahidullah H. Naevi and other developmental defects. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. Oxford: Wiley-Blackwell; 2010. p. 18.11-12.  Back to cited text no. 1
    
2.
Thomas VD, Swanson NA, Lee KK. Benign epithelial tumors, hamartomas and hyperplasias. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, editors. Fitzpatrick's Dermatology in General Medicine. New York: McGraw Hill; 2008. p. 1059-60.  Back to cited text no. 2
    
3.
Kofmann S. A case of rare localization and spreading of Comedones. Arch Dermatol Syphilol 1895;32:177-8.  Back to cited text no. 3
    
4.
Ghaninezhad H, Ehsani AH, Mansoori P, Taheri A. Naevus comedonicus of the scalp. J Eur Acad Dermatol Venereol 2006;20:184-5.  Back to cited text no. 4
    
5.
Sikorski D, Parker J, Shwayder T. A boy with an unusual scalp birthmark. Nevus Comedonicus Int J Dermatol 2011;50:670-2.  Back to cited text no. 5
    

What is new?
Nevus comedonicus affecting scalp.


    Figures

  [Figure 1], [Figure 2]



 

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