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E–CASE REPORT |
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| Year : 2013 | Volume
: 58
| Issue : 2 | Page : 158 |
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| Nevus depigmentosus treated with suction blister grafting: Follow-up after 10 years |
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Bikash Ranjan Kar
Department of Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| Date of Web Publication | 5-Mar-2013 |
Correspondence Address:
Bikash Ranjan Kar
Department of Dermatology, IMS and SUM Hospital, Bhubaneswar-3, Odisha-751 003
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5154.108074
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 Abstract | | |
Nevus depigmentosus is a congenital hypomelanotic condition for which no effective treatments are available. The hypopigmentation is permanent and enlarges in proportion with growth in the person. Here, I report a patient of nevus depigmentosus on whom we performed suction blister grafting and the resultant pigmentation was satisfactory even at a follow-up after 10 years.
Keywords: Long term follow up, nevus depigmentosus, suction blister grafting
How to cite this article:
Kar BR. Nevus depigmentosus treated with suction blister grafting: Follow-up after 10 years. Indian J Dermatol 2013;58:158 |
What was known?
1. Nevus depigmentosus is a hypomelanotic condition which is usually refractory to medical modalities of treatment.
2. A few cases of surgical repigmentation have been reported.
3. One case report from South Korea described the recurrence of hypomelanosis at the surgically treated site after eight years.
| Introduction | |  |
Nevus depigmentosus (ND) is a rare, congenital, stable hypomelanosis first described by Lesser in 1884. [1] The lesions usually present as dermatomal or quasidermatomal macules commonly on the trunk, lower abdomen, or proximal extremities. They are off-white in colour and have irregular, serrated, feathered, or geographic margins. The face, when involved, is a cause of social embarrassment for the patient. Unfortunately, there is no effective treatment for this condition. Here we report a patient of ND treated successfully with suction blister grafting, in whom the pigment has been well maintained even after 10 years.
| Case Report | | |
A 15-year-old female student presented with a hypopigmented asymptomatic macule on the left half of the upper lip [Figure 1] slightly extending to the left cheek, since birth. The lesion measured 2 × 5 cm. On pressing the lesional border, there was no disappearance of the hypopigmentation. Wood's lamp examination showed an off-white accentuation. Examination of other areas of the skin did not reveal any similar lesions or any other type of skin lesions and the other systems particularly the skeletal and nervous system were within normal limits. Her investigation revealed normal blood counts; liver function test (LFT), renal function test (RFT), clotting profile, and test for HIV were negative. | Figure 1: Nevus depigmentosus distributed on the left half of the upper lip with extension to the chin
Click here to view |
In March 2002, suction blister grafting was performed on her after taking informed consent. Multiple blisters were raised on the left thigh using a suction blister technique described by Gupta et al.[2] The recipient site was dermabraded with the loop electrode of radiosurgery equipment. Then, the blister roof from the thigh was removed with the help of iris scissors, transferred on to a glass slide; the edges were trimmed to fit the shape of the recipient area and then applied on to the recipient ND site [Figure 2]. When the dressing was removed after 48 hours, the grafts were well taken. The patient was put on topical PUVASOL (Psoralen plus UltraViolet-A of SOLar origin) after the grafts fell off and the resultant pigmentation was satisfactory at a follow-up after 1 month.
The patient followed up in the clinic after a gap of 10 years in May 2012, and on examination, it was found that the pigmentation achieved with suction blister grafting was well maintained [Figure 3], though there were a few areas of patchy hyperpigmentation toward the angle of the lip on the left side. | Figure 3: Repigmentation at the site of nevus depigmentosus 10 years after suction blister grafting
Click here to view |
| Discussion | | |
ND is a congenital pigmentary disorder. The disease is primarily limited to the skin though there are reports of association [3] of neurological abnormalities and limb hypertrophy . The commonly used clinical diagnostic criteria for ND are as follows: [4]
- Leukoderma present at birth or of an early onset
- No alteration in the distribution of leukoderma throughout life
- No alteration in texture or change in sensation in the affected area
- Absence of hyperpigmented border
Lee et al. found that the majority (92.5%) of ND present before the age of three years and have serrated irregular borders (77.4%). [5] ND is generally classified as isolated, segmental, and whorled types. Wood's lamp examination shows an off-white accentuation in ND as compared to the chalky white accentuation in the case of vitiligo.
Ravikumar et al.[6] described the procedure of suction blister grafting as helpful in ND but the follow-up details in that case were not known. Kim et al.[7] reported a case of recurrence of ND eight years after autologous epidermal grafting where he considered the newly developed hypopigmented macules to be a functional impairment of melanocytes in ND. In the present case, the follow-up was after 10 years and the pigment gained after suction blister grafting was stable. Repigmentation in ND depends on the surgical procedure adopted. The epidermal sheets used for grafting in ND should completely cover the area of ND for a uniform repigmentation. [8] In contrast, there have been reports of poor quality of repigmentation with cell suspension or melanocyte keratinocyte transplantation. [9],[10]
As the resultant cosmetic discomfort for facial lesions of ND can be embarrassing to the patient and no effective therapeutic options are available, surgical repigmentation with blister grafting should be offered to all interested patients.
| References | | |
| 1. | Lesser E. In: Ziemssen HV, editor. Hanbuchder Hautkrankheiten, 2 nd ed. Leipzig: Vogel; 1884. p. 183. 
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| 2. | Gupta S, Schroff S, Gupta S. Modified technique of suction blistering for epidermal grafting. Int J Dermatol 1999:38:306-9.
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| 3. | Di Lernia V. Segmental nevus depigmentosus: Analysis of 20 patients. Pediatr Dermatol 1999;16:349-53.
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| 4. | Shim JH, Seo SJ, Song KY, Hong CK. Development of multiple pigmented nevi within segmental nevus depigmentosus. J Korean Med Sci 2002;17:133-6.
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| 5. | Lee HS, Chun YS, Hann SK. Nevus depigmentosus: Clinical features and histopathologic characteristics in 67 patients. J Am Acad Dermatol 1999;40:21-6.
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| 6. | Ravikumar BC, Sabitha L, Balachandran C. Naevus depiomentosus treated with suction blister grafting. Indian J Dermatol Venereol Leprol 2000;66:89-90.
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| 7. | Kim DY, Park YK, Hann SK. Recurrence of nevus depigmentosus after an autologous epidermal graft. J Am Acad Dermatol 2008;58:527-8.
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| 8. | Gupta S, Goel A. Nevus depigmentosus needs transplant of epidermal sheets. Dermatol Surg 2005;31:1746-7.
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| 9. | Mulekar SV, Al Issa A, Al Eisa A. Nevus depigmentosus treated by melanocyte-keratinocyte transplantation. J Cutan Aesthet Surg 2011;4:29-32.
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| 10. | van Geel N, Wallaeys E, Goh BK, De Mil M, Lambert J. Long term results of non cultured epidermal cellular grafting in vitiligo, halo nevi, piebaldism and nevus depigmentosus. Br J Dermatol 2010;163:1186-93.
[PUBMED] |
What is new?
Pigmentation was well maintained at the site of suction blister grafting after
10 years, and hence, suction blister grafting should be offered to all willing patients.
[Figure 1], [Figure 2], [Figure 3] |
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| This article has been cited by | | 1 |
Clinical and ultrastructural study of nevus depigmentosus |
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| El-Sayed S. Hewedy,Arwa M. Hassan,Ehsan F. Salah,Fersan A. Sallam,Naeem M. Dawood,Reda H. Al-Bakary,Hagar A. Al-Sharnoby | | Journal of Microscopy and Ultrastructure. 2013; 1(1-2): 22 | | [Pubmed] | [DOI] | |
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