Nevus Comedonicus Clinical Presentation

Updated: Jan 27, 2020
  • Author: Marjon Vatanchi, MD; Chief Editor: William D James, MD  more...
  • Print
Presentation

History

The lesions are typically present at birth or develop in early childhood. They are usually asymptomatic. However, one case report described itching as an accompanying symptom. Patients usually seek help for cosmetic reasons. The lesions grow as the patient does and often grow faster at puberty. Patients may be able to express keratinaceous material from the pores.

With the inflammatory form, repeated bacterial infections, drainage, cysts, fistula and abscess formation, and scarring may develop. [9, 10, 11] Reports from 2015 and 2016 describe nevus comedonicus syndrome complicated by hidradenitis suppurativa‒like lesions. [12, 13] More recent reports detail cases of nevus comedonicus on the scalp with late-onset presentation. [14, 15]

Next:

Physical Examination

The lesion appears as a collection of discrete, dilated follicular ostia plugged with pigmented keratinaceous material. [16, 17] Dermoscopy displays multiple, well-defined structureless brown homogenous circular pores with keratin plugs. [18] They can be single or multiple, usually unilateral, and range in size from a few centimeters to involving half of the entire body.

Nevus comedonicus is typically found on the face, trunk, neck, and upper extremities. [19, 20, 21, 22] Rarely, it has been described on the palms [23] and soles, scalp, [24, 25] or penis. [26] When it occurs on the elbows and knees, it can appear as verrucous nodules. When it occurs in the intertriginous zones, the mechanical stress can produce hidradenitis suppurativa–like lesions. [27]

Nevus comedonicus may be linear, interrupted, unilateral, bilateral, present in a dermatomal distribution, following the lines of Blaschko, or segmental. [11, 28, 29, 30, 31, 32, 33]

Nevus comedonicus syndrome is the association of nevus comedonicus with abnormalities in the central nervous system, skeletal system, skin, and eyes as follows:

  • Central nervous system - Epilepsy, electroencephalogram abnormalities, transverse myelitis, microcephaly

  • Skeletal system - Scoliosis, hemivertebrae, spina bifida occulta, foot deformities, absent fifth finger, syndactyly, supernumerary digits

  • Skin - Ichthyosis, trichilemmal cysts, leukoderma, white hairs, Sturge-Weber syndrome, hemangiomas, linear basal cell nevus

  • Eye - Congenital cataracts (unilateral and bilateral) [34]

  • Other - Bilateral oligodontia, [35] multiple basal cell carcinomas, rare systemic malignancies

Previous
Next:

Complications

Persons with inflammatory nevus comedonicus can develop cysts, recurrent bacterial infections, fistulae, and abscesses, and these may subsequently heal with scarring. Treat these lesions with appropriate antibiotics or surgical drainage. Infections may be recurrent.

Previous