Patient Care - Allergy & Immunology - October 2007 - (Page 28)

I Dermatology Case Challenge Becker’s nevus First described in 1948, the Becker’s nevus has an uncertain pathogenesis. Androgens appear to play a role, however, since the lesion becomes prominent around puberty, is more common in males, is associated with hypertrichosis, and has increased androgen receptors. The prevalence is 1 in 200 in males; the lesion is much less common in females. Becker’s nevus occurs sporadically, although there have been congenital and familial cases reported. A Becker’s nevus often presents as a unilateral, asymptomatic, irregular tan-brown patch measuring several centimeters, most commonly on the shoulders, upper chest, or back. Uncommonly present at birth, it becomes more prominent during puberty and can expand as peripheral macules and patches coalesce into the larger patch. Several months to years after the brown pigmentation appears, up to 50% of patients develop brown or black coarse hairs in and around the patch. The central area in the patch can even thicken and, rarely, develop acne within it. The patch remains indefinitely, with possible slight fading in color in adulthood. A Becker’s nevus is an organoid nevus with hamartomatous elements, not a melanocytic nevus. There is an association with ipsilateral hypoplasia of breast and skeletal anomalies, including scoliosis, spina bifida occulta, and ipsilateral hypoplasia of a limb, which has been termed the Becker’s nevus syndrome, a sporadic condition. With the exception of this syndrome, Becker’s nevus is considered a benign process in most cases, although there have been a few reports of melanoma within a nevus. The differential diagnosis, particularly early in the process, includes congenital melanocytic nevus, nevus spilus, café au lait patch, or postinflammatory hyperpigmentation. The diagnosis is usually clinical, although a skin biopsy can provide histologic diagnosis and helps distinguish a Becker’s nevus from other clinical entities, all of which are benign. Histopathology shows mild acanthosis and hyperkeratosis of the epidermis, papillomatosis, and increased basal cell pigmentation. Clinical hypertrichosis correlates with an increased number of morphologically normal follicular units. Most cases demonstrate an increase in dermal smooth muscle. Patients should be informed that this is a benign entity that does not require treatment except for cosmetic reasons. Patient concerns may focus on the hyperpigmentation and/or hypertrichosis. Q-switched ruby laser (694 nm) has been used with variable success in the treatment of both the hypertrichosis and hyperpigmentation of Becker’s nevus. Electrolysis is another option for the hypertrichosis. 28 PATIENT CARE ALLERGY & IMMUNOLOGY www.patientcareonline.com http://www.patientcareonline.com

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Patient Care - Allergy & Immunology - October 2007 Research Digest Contents Medicine in the News When to Suspect Celiac Disease and How to Proceed From There Averting Angioedema’s Potentially Dire Consequences Is There a Role for Leukotriene Receptor Antagonists in Treating Allergic rhinitis? Clinical Clips Dermatology Case Challenge Classified Advertising

Patient Care - Allergy & Immunology - October 2007

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