An additional case of linear and whorled nevoid hypermelanosis associated with birth defects and mental retardation

Linear and whorled nevoid hypermelanosis and Joubert syndrome: a novel association: A case report and literature review

This report discusses a case of linear and whorled nevoid hypermelanosis associated with cerebellar atrophy, ocular and developmental anomalies compatible with Joubert syndrome. Linear and whorled nevoid hypermelanosis is a rare disorder of skin pigmentation characterized by swirls and whorls of hyperpigmented macules in a reticulate pattern along Blaschko’s lines. Neurologic, cardiac, skeletal and developmental anomalies have been reported. We present a case of linear and whorled nevoid hypermelanosis on an 18-year-old woman who also presented with cerebellar atrophy, jerk nystagmus, macrocephaly and developmental delay. Those symptoms were compatible with Joubert syndrome. A complete work-up failed to reveal other systemic or skeletal anomalies. No chromosomal alteration was found on karyotyping carried out on a skin specimen. Much remains to be known about linear and whorled nevoid hypermelanosis. It is generally a benign condition but association with various congenital anomalies have been reported. Proper work-up is advised in order to exclude congenital anomalies.

Cutaneous findings in children with intellectual disabilities

The link between pediatric dermatology and intellectual disabilities (ID) is revised, according to the author's personal experience and the existing published work. Cutaneous manifestations in children with ID can be: (i) a key element to reach a diagnosis, as in neurodermatoses; (ii) a peculiar sign to define a complex syndrome; (iii) linked to behavioral features; (iv) iatrogenic, caused by drugs, as a side-effect; and (v) independent from ID.

Linear and whorled nevoid hypermelanosis: dermatoscopic features

Linear and whorled nevoid hypermelanosis (LWNH) is a pigmentation disorder characterized by macular hyperpigmentation following the lines of Blaschko. Dermatoscopy can be used in the differential diagnosis of this pigmentation disorder. To our knowledge, the dermatoscopic features of pigmented lesions in LWNH have not been described previously. Here, a case of LWNH is discussed together with its dermatoscopic findings. An 11-year-old girl presented to our department with hyperpigmentation along the lines of Blaschko over the entire body. The mental status of the patient was normal and no associated anomaly was detected in the physical examination or genetic analysis. Dermatologic examination revealed a whorled-like configuration of hyperpigmented macules on the neck, trunk, and buttocks, and a linear configuration of hyperpigmented macules, some of which were arranged in a parallel linear fashion on the extremities along the lines of Blaschko. Histopathologic examination confirmed the diagnosis. Dermatoscopic examination revealed linear or circular arrangement of streak-like pigmentations arranged in a parallel manner. This is the first known reported case of LWNH that describes its dermatoscopic findings. Dermatoscopy may be used to facilitate the differential diagnosis of melanotic lesions of this pigmentation disorder.

Linear and whorled hypermelanosis

Linear and whorled nevoid hypermelanosis is a sporadic pigmentary anomaly occurring within the first weeks of life, characterized clinically by swirls and streaks of macular hyperpigmentation following the lines of Blaschko. Histologically it shows only epidermal melanosis. Underlying chromosomal mosaicism has been demonstrated in only a few published cases. Progressive cribriform and zosteriform hyperpigmentation is considered to be the localized variant of linear and whorled nevoid hypermelanosis. We report a retrospective study on 16 children referred consecutively over a 10-year period for evaluation of segmental, linear or swirled hyperpigmentation distributed along the lines of Blashko, consistent with a diagnosis of linear and whorled nevoid hypermelanosis. Associated abnormalities were found only in one out of six patients with the diffuse form (linear and whorled nevoid hypermelanosis-type) and in none of the remaining 10 children presenting the unilateral form (progressive cribriform and zosteriform hyperpigmentation-type). A long-term follow-up did not disclose further abnormalities. The authors discuss the nosologic position of this entity with respect to hypomelanosis of Ito. Linear and whorled nevoid hypermelanosis and hypomelanosis of Ito should be not considered single entities, but be rather grouped as a heterogeneous collection of nonspecific pigmentary disorders caused by genetic mosaicism. Skin findings in these diseases can differ according to the pigmentation in the normal cell line and whether the second line contains more or less melanosomes than the normal skin of the individual exhibiting mosaicism.

Congenital curvilinear palpable hyperpigmentation

We report two cases of congenital curvilinear palpable hyperpigmentation on the posterior aspect of bilateral legs in male infants. These lesions appeared shortly after birth and mimicked child abuse with looped cord or postinflammatory hyperpigmentation. Histopathologic features showed lentiginous melanocytic hyperplasia. One of the boys also had severe global developmental delay with abnormal findings from magnetic resonance imaging of the brain. We believe that these lesions represent a new type of congenital hyperpigmentation that we termed "congenital curvilinear palpable hyperpigmentation." Although these lesions do not follow the lines of Blaschko, they may also be associated with neurologic and developmental abnormalities.

Linear and whorled naevoid hypermelanosis: a case with systemic involvement and trisomy 18 mosaicism

We describe a 20-year-old woman with trisomy 18 mosaicism, who presented with skeletal anomalies, epilepsy, mental retardation, and linear and whorled naevoid hypermelanosis.