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CORRESPONDENCE COLUMN |
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| Year : 2005 | Volume
: 50
| Issue : 3 | Page : 173 |
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| Discoid lupus erythematosus on Becker's nevus |
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Subhav Kumar Agrawal, Archana Singal, Deepika Pandhi
Department of Dermatology & Venereology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi-110 095, India
Correspondence Address:
Subhav Kumar Agrawal
Department of Dermatology & Venereology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi-110 095
India
 Source of Support: None, Conflict of Interest: None  | Check |
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How to cite this article:
Agrawal SK, Singal A, Pandhi D. Discoid lupus erythematosus on Becker's nevus. Indian J Dermatol 2005;50:173 |
Becker's nevus is considered as an organoid epidermal nevus of late onset[1] with focal epidermal melanotic hypermelanosis. Increased number of androgen receptors in the lesional skin, late onset, male predominance, and hypertrichosis suggests that local androgen hypersensitivity may be the major etiological factor.[1] We describe an unusual case of discoid lupus erythematosus on Becker's nevus.
A 40 years old male presented to dermatology outpatients with multiple depigmented plaques all over the body including face and scalp of 8 years duration. All plaques had well defined margins, adherent scales, follicular plugging, leukotrichia and atrophy. Lesional biopsy performed on prior occasion was consistent with the clinical diagnosis of disseminated discoid lupus erythematosus (DLE). Detailed clinical, hematological, radiological and serological parameters didn't indicate systemic involvement. Patient was treated with oral chloroquine (250mg twice daily), topical sunscreen and steroid application for one year with satisfactory outcome. Cutaneous examination also revealed a well defined hairy patch with speckled brownish pigmentation on his back just below the right scapula [Figure - 1]. This asymptomatic lesion appeared at around 14 years of age and slowly became darker and bigger in size, and developed coarse hairs. A clinical diagnosis of Becker's nevus (BN) was supplemented by histopathology. The depigmented DLE patches overlying BN were strictly limited by the nevus margins. The hairs over DLE patches had turned white while remained black on rest of BN lesion [Figure - 1].
Becker's nevus, first described in 1949,[2] is an epidermal nevus seen in about 0.5% of young men and is five times more common in males than females.[1] Majority of the cases are noted around puberty and familial cases have also been described.[3] It is usually asymptomatic, localized unilaterally over the shoulder, anterior chest or scapular region.
Acne,[4] hypopigmented pityriasis versicolor,[5] smooth muscle hamartomas, fibrous dysplasia, and many other associations[1] have been reported from time to time. Histopathology shows acanthosis, papillomatosis, thickening of the dermis, and smooth muscle hyperplasia. Ultra structure showed increased melanocytes activity and increased number of melanosome complexes in keratinocytes, consistent with enhanced melanin synthesis.[1]
Discoid lupus erythematosus overlying BN has never been reported earlier. Strict localization of DLE patches within margins of BN leading to subsequent depigmentation and leukotrichia in the lesional skin is certainly unique and intriguing.
 References | |  |
| 1. | Atherton DJ. Naevi and other developmental defects. In: Champion RH, Burton JL, Burns DA, et al, eds. Textbook of Dermatology. 6th ed. Oxford, Blackwell Sciences Ltd, 1998: 542-3.  |
| 2. | Becker SW. Concurrent melanosis and hypertrichosis in distribution of nevus unius lateris. Arch Dermatol 1949; 60: 155-60. |
| 3. | Panizzon RG, Schnyder UW. Familial Becker's nevus. Dermatologica 1988; 176: 275-6. |
| 4. | Agrawal S, Garg VK, Sah SP, et al. Acne in Becker's nevus. Int J Dermatol 2001; 40(9): 583-5. |
| 5. | Singal A, Bhattacharya SN, Kumar S, et al. Hypopigmented pityriasis versicolor on Becker's nevus: Hope for new method of treatment. Ind J Dermatol Venereol Leprol 1998; 64(3): 137-8. |
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