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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 6  |  Issue : 1  |  Page : 51-52

Generalized unilateral porokeratotic eccrine ostial and dermal duct nevus along the lines of blaschko: A rare entit


1 Department of Dermatology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
2 Department of Dermatology, HBT Medical College and Dr. RN Cooper Hospital, Mumbai, Maharashtra, India

Date of Web Publication13-Jun-2019

Correspondence Address:
Ankita Agrawal
Department of Dermatology, HBT Medical College and Dr. RN Cooper Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdpdd.ijdpdd_47_18

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How to cite this article:
Gupta AK, Agrawal A, Rambhiya K, Makhecha M. Generalized unilateral porokeratotic eccrine ostial and dermal duct nevus along the lines of blaschko: A rare entit. Indian J Dermatopathol Diagn Dermatol 2019;6:51-2

How to cite this URL:
Gupta AK, Agrawal A, Rambhiya K, Makhecha M. Generalized unilateral porokeratotic eccrine ostial and dermal duct nevus along the lines of blaschko: A rare entit. Indian J Dermatopathol Diagn Dermatol [serial online] 2019 [cited 2019 Jul 16];6:51-2. Available from: http://www.ijdpdd.com/text.asp?2019/6/1/51/260187



Sir,

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a congenital hamartoma with eccrine differentiation. It is characterized by asymptomatic-grouped keratotic papules and plaques arranged in linear pattern usually localized on the palms and soles with distinct histopathological features. Here, we report a case of generalized PEODDN following the  Lines of Blaschko More Details. A 22-year-old female presented with asymptomatic keratotic papules and plaques on the right side of the face, back, and right upper extremity including palm and nail since 4 years of age. There was no history of similar complaints in the family. Cutaneous examination revealed discrete keratotic papules, few papules coalescing to form hyperkeratotic plaques with central keratinous, comedo-like plugs, and pits in a linear configuration following the lines of Blaschko. These lesions were distributed linearly over the right palm extending above the wrist to the tips of fingers, forearm, arm, and right side of back not crossing the midline and right side of chin and cheek [Figure 1] and [Figure 2]. On dermoscopy, punctate pits filled with a keratin plug [Figure 3]a and involved nail showed yellow dot arranged in a linear fashion [Figure 3]b. Our clinical differential diagnosis was inflammatory linear verrucous epidermal nevus (VEN) and Blaschkoid PEODDN. General physical examination was normal. We took biopsy from papule over the palm and forearm and both revealed similar histopathology. Histopathological examination revealed orthokeratosis, and parakeratotic column filling a deep cup-shaped invagination in the epidermis [Figure 4]. Epidermis at the base of column showed loss of granular cells replaced by cluster of dyskeratotic cells. An eccrine duct was seen at the base of invagination consistent with acrosyringeal origin. The patient was given topical keratolytics in the form of 10% urea and 6% salicylic ointment.
Figure 1: Linearly arranged keratotic papules and plaques unilaterally over the right side of the face and neck (a) and right side of the back and arm (b)

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Figure 2: Keratotic papules and plaque over the palm

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Figure 3: Dermoscopy showing punctate pits filled with a keratin plug (a) and involved nail showed yellow dot arranged in a linear fashion (b)

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Figure 4: Histopathological examination revealed orthokeratosis, and parakeratotic column filling a deep cup-shaped invagination in the epidermis with coronoid lamellae (upper arrow), middle arrow showing acrosyringium and dermis showing eccrine duct involvement lower arrow (H and E, ×4)

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The PEODDN is a rare disorder of keratinization. The term “PEODDN” was introduced after the description of Abell and Read who reported PEODDN in 1980.[1] The disease is characterized histologically by well-formed cornoid lamellae occurring in association with dilated eccrine ducts and acrosyringia. It is composed of small keratotic papules or comedo-like pits filled with keratotic plugs in a linear distribution. PEODDN usually has unilateral distribution on the distal portion of a limb, on the palm or sole. A wider distribution of the disorder is a rare occurrence. Face and neck have not described in the literature but are found in our case. Association with other conditions is rare and includes neurological problems, scoliosis, palmoplantar keratoderma, onychodysplasia, alopecia, and hyperthyroidism. Evidence of the possible occurrence of the PEODDN along Blaschko lines as shown by our patient has been reported only in few cases.[2]

The lack of carcinoembryonic antigen expression by acrosyringial cells leads to development of the disease as proposed by Stoof et al.[3] Histopathology of PEODDN is diagnostic which shows epidermal invaginations containing cornoid lamella that involves the eccrine ducts. Differential diagnosis includes linear VEN, inflammatory linear VEN, linear porokeratosis, linear psoriasis, punctuate keratoderma, and nevus comedonicus. However, dissimilar to other forms of porokeratosis, this condition appears to be congenital and occurs exclusively in association with acrosyringia, the intraepidermal portions of theccrine sweat ducts. The course of PEODDN is usually stationary or sometimes progressive. Treatment of PEODDN is generally unsatisfactory.[4] Long-term involution of the lesions has been observed rarely. The lesions are benign and no malignant transformation had been reported. Small and localized lesions may be surgically excised. There was little success with topical corticosteroids, tar, psoralen ultraviolet A, ultraviolet B, anthralin, keratolytics, and retinoids. Good results with laser therapy, in the form of ultrapulse CO2 laser and combined erbium/CO2 laser, have been reported.[5] This case is reported due to rarity of generalized PEODDN.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wang NS, Meola T, Orlow SJ, Kamino H. Porokeratotic eccrine ostial and dermal duct nevus: A report of 2 cases and review of the literature. Am J Dermatopathol 2009;31:582-6.  Back to cited text no. 1
    
2.
Goddard DS, Rogers M, Frieden IJ, Krol AL, White CR Jr., Jayaraman AG, et al. Widespread porokeratotic adnexal ostial nevus: Clinical features and proposal of a new name unifying porokeratotic eccrine ostial and dermal duct nevus and porokeratotic eccrine and hair follicle nevus. J Am Acad Dermatol 2009;61:1060.e1-14.  Back to cited text no. 2
    
3.
Stoof TJ, Starink TM, Nieboer C. Porokeratotic eccrine ostial and dermal duct nevus. Report of a case of adult onset. J Am Acad Dermatol 1989;20:924-7.  Back to cited text no. 3
    
4.
Pathak D, Kubba R, Kubba A. Porokeratotic eccrine ostial and dermal duct nevus. Indian J Dermatol Venereol Leprol 2011;77:174-6.  Back to cited text no. 4
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5.
Wong JW, Summers EM, Taylor MB, Harris RM. Porokeratotic eccrine ostial and dermal duct nevus treated with a combination erbium/CO2 laser: A case and brief review. Dermatol Online J 2011;17:10.  Back to cited text no. 5
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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