|THE CLINICAL PICTURE
|Year : 2022 | Volume
| Issue : 2 | Page : 141-142
Midline nevoid acanthosis nigricans
Priyanka A Kowe, Shashank K Agrawal, Vaishali H Wankhade
Department of Dermatology, Venereology, and Leprology, Government Medical College and Hospital, Nagpur, Maharashtra, India
|Date of Submission||23-Mar-2020|
|Date of Decision||20-Jul-2020|
|Date of Acceptance||14-Mar-2021|
|Date of Web Publication||12-Aug-2022|
Dr. Vaishali H Wankhade
Associate Professor, Department of Dermatology, Venereology, and Leprology, Government Medical College and Hospital, Nagpur, Maharashtra
Source of Support: None, Conflict of Interest: None
Keywords: Dermoscopy, nevoid, papillomatosis
|How to cite this article:|
Kowe PA, Agrawal SK, Wankhade VH. Midline nevoid acanthosis nigricans. Pigment Int 2022;9:141-2
A 16-year-old male presented with gradually progressive, asymptomatic, thick lesion over midline of abdomen and chest for 4 years. He was born to non-consanguineous parents with no other family members affected with similar disease. He was nonobese (body mass index: 18.2 kg/m2) and had no endocrinopathy. There was neither any history of drug intake prior to onset of lesion, nor significant weight loss. Examination revealed overlying well-demarcated, hyperpigmented velvety plaque with soft ridges in supra umbilical area extending linearly up to the chest [Figure 1]. Based on history and examination, we kept differential diagnosis of inflammatory linear verrucous epidermal nevus (ILVEN) and nevoid acanthosis nigricans (AN). Dermoscopy using 3Gen DermLite DL4 (CA, USA) 10× polarized mode, showed multiple linear crista cutis and sulcus cutis with hyperpigmented dots in the crista cutis [Figure 2]a. Histopathological examination revealed hyperkeratosis, irregular acanthosis, hyperpigmentation of basal layer, and papillomatosis with upward projection of dermal papillae. Dermis showed pigment incontinence and perivascular lymphocytic infiltrate [Figure 2]b. Based on history, clinical findings, dermoscopy, and skin biopsy we made the final diagnosis of nevoid variant of AN. Patient was counselled and advised tretinoin 0.05% cream at night and 12% urea containing moisturizers in daytime.
|Figure 1 Hyperpigmented velvety plaque with soft ridging in supra umbilical area extending linearly up to the chest|
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|Figure 2 (a) Dermoscopy showing multiple crista cutis (green arrow) and sulcus cutis (red arrow) with hyperpigmented dots in crista cutis (blue arrow) (polarized; original magnification: 10×). (b) H and E showing hyperkeratosis (red arrow), irregular acanthosis (green arrow), papillomatosis, increased basal layer pigmentation (blue arrow), and dermal melanophages (black arrow) (H and E, 10×)|
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Schwartz categorized AN into the eight variants: obesity associated, syndromic, benign, malignant, drug induced, acral, mixed, and unilateral. Unilateral nevoid acanthosis nigricans (UNAN) is a term which denotes blaschkoid, linear, unilateral distribution of classic AN lesion. Inherited as irregularly autosomal dominant trait, it can present at birth, childhood, puberty, or in middle-aged adults. Sites of involvement reported previously are: scalp, face, back, chest, abdomen, periumbilical area, thigh, and flexures. There are very few reports of midline involvement which we observed in our case. The condition needs to be differentiated from verrucous epidermal nevus and ILVEN which resembles AN clinically. Dermoscopy plays an important bedside tool to differentiate and diagnose such similar looking entities. The closest dermoscopic differentials of AN include confluent and reticulated papillomatosis of Gougerot–Carteaud syndrome and idiopathic eruptive macular pigmentation., Further confirmation can be done by routine skin biopsy with hematoxylin and eosin staining. Various treatments that have been tried are keratolytics such as retinoid, ammonium lactate creams, calcipotriene, fish oil, cryotherapy, dermabrasion, excision, and long-pulse alexandrite lasers. Recently Campos et al. treated a case of UNAN successfully with CO2 laser. Midline distribution of the lesion with characteristic linear pattern, absence of family history, and other systemic abnormalities prompted us to report this case.
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Conflicts of interest
There are no conflicts of interest.
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Campos MA, Varela P, Baptista A, Ferreira EO. Unilateral nevoid acanthosis nigricans treated with CO2 laser. BMJ Case Rep 2016;2016:bcr2016216073.
[Figure 1], [Figure 2]