Progressive cribriform and zosteriform hyperpigmentation - the late onset linear and whorled nevoid hypermelanosis

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.

Progressive cribriform and zosteriform hyperpigmentation

Here we report a case of a healthy 30-year-old male who presented to us with progressively increasing reticulate pigmented lesions following lines of Blaschko on the right side of abdomen and back. Skin biopsy revealed increased basal layer pigmentation without nevus cells. A diagnosis of progressive cribriform and zosteriform hyperpigmentation (PCZH) was made on clinicopathological correlation. We also discuss clinicopathological differentials of this peculiar pigmentary disorder.

X-Linked reticulate pigmentary disorder in a female patient

BACKGROUND

X-linked reticulate pigmentary disorder is a very rare cutaneous condition characterized by different clinical manifestations according to sex.

METHODS

We report a 31-year-old woman with X-linked reticulate pigmentary disorder.

RESULTS

On examination, there were multiple, asymptomatic, brownish macules in linear and whorled patterns over the trunk, axillae, groin, and extremities. The woman had not experienced any systemic manifestations involving the gastrointestinal, pulmonary, or ocular systems. Her hair, teeth, and nails were normal on close observation. All laboratory data were within the normal range. A genetic study was not performed.

CONCLUSIONS

Although a genetic study was not performed, we believe that our patient can be diagnosed with X-linked reticulate pigmentary disorder according to the clinical and histopathologic findings.

Linear and whorled nevoid hypermelanosis complicated with inflammatory linear verrucous epidermal nevus and ichthyosis vulgaris

We report a 17-year-old girl who presented with linear and whorled melanosis following Blaschko lines mainly on her trunk. Ichthyosiform lesions and linear scaling erythemas were observed respectively on her lower limbs and the dorsa of her hands, left knee, ankle and foot. No abnormality was found in systemic examination and blood tests. A biopsy specimen of pigmentation of her back showed there was increased pigmentation within the basal keratinocytes, with focal incontinentia pigmenti. Notable lymphangiectasis could also be seen in the mid part of dermis, which had never previously been described. The biopsy of scaling erythemas of her hand showed dominant hyperkeratosis with focal parakeratosis, acanthosis and papillomatous hyperplasia in the epidermis. The diagnosis of linear and whorled nevoid hypermelanosis (LWNH) complicated with inflammatory linear verrucous epidermal nevus and ichthyosis vulgaris was made in accordance with clinical and pathological manifestations. LWNH ought to be differentiated from incontinentia pigmenti and hypomelanosis of Ito.

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.