Abstract:

Perinevic dermatosis neglecta is an underestimated skin condition usually affecting children and adolescents, characterized by the appearance of dirt-like brownish pigmentation around a preexisting nevus and often a matter of concern for parents. We describe the clinical and dermoscopic findings in a case of perinaevic dermatosis neglecta and discuss the possible etiology of this phenomenon.

Keywords:
Dermatology; Dermoscopy; Pediatrics

Dear Editor,

We recently saw a 12-year-old boy who was referred to our clinic for evaluation of a “sudden” change in a preexisting nevus on the neck, characterized by perinevic hyperpigmentation (Figure 1A). His parents reported that he had avoided washing the area because he was afraid of injuring the nevus. Dermoscopy showed a cobblestone-arranged accumulation of pigmented keratin (previously described as “cornflake-like”) surrounding a clear-cut benign dermal nevus, promptly supporting the diagnosis of ‘perinevic dermatosis neglecta' (PDN) (Figure 1B).¹1 Errichetti E, Stinco G. Dermoscopy in terra firma-forme dermatosis and dermatosis neglecta. Int J Dermatol. 2017;56:1481-3. After accurate alcohol swabbing, the hyperpigmentation disappeared both on clinical and dermoscopic examination (Figures 2A-B).

Although dermatosis neglecta (DN) and terra firma-forme dermatosis (TFFD) have been thoroughly described in the literature, no information has been published on the existence of PDN.¹1 Errichetti E, Stinco G. Dermoscopy in terra firma-forme dermatosis and dermatosis neglecta. Int J Dermatol. 2017;56:1481-3.

2 Greywal T, Cohen PR. Non-invasive methods to establish the diagnosis of terra firma-forme dermatosis: The SMART (Skin Modified by Alcohol Rubbing Test) evaluation and dermoscopy. Dermatol Online J. 2016;22. pii:13030/qt7jk6k6d9._-³3 Aslan NÇ, Güler S, Demirci K, Isiyel E. Features of Terra Firma-Forme Dermatosis. Ann Fam Med. 2018;16:52-4. We thus take the opportunity to discuss PDN, a likely underdiagnosed and underreported skin condition, usually affecting children or adolescents, who may avoid washing around a dermal nevus for fear of touching or injuring it. Two factors may help explain this strange phenomenon. First, the myth that traumatized nevi turn into melanomas, which may make people more cautious when scrubbing their skin around dermal nevi.⁴4 Piccolo V, Russo T, Giacomel J, Lallas A, Alfano R, Argenziano G. Dispelling myths concerning pigmented skin lesions. J Eur Acad Dermatol Venereol. 2016;30:919-25. The second factor is age-related: when children and adolescents begin assuming responsibility for their own bodily cleanliness, they tend to be less monitored by their parents and thus could also be less observant of their personal hygiene. Alcohol swabbing and parents' reassurance are the best management strategies in PDN. Dermoscopy of TFFD and DN have been described recently, underlining the usefulness of dermoscopy for the diagnosis.¹1 Errichetti E, Stinco G. Dermoscopy in terra firma-forme dermatosis and dermatosis neglecta. Int J Dermatol. 2017;56:1481-3. However, to the best of our knowledge, no data have been published in the literature on PDN or its dermoscopic appearance.

Most melanocytic lesions in children and adolescents are benign and easy to diagnose, although a few worrisome and problematic lesions do exist and must be recognized.⁵5 Moscarella E, Piccolo V, Argenziano G, Lallas A, Longo C, Castagnetti F, et al. Problematic lesions in children. Dermatol Clin. 2013;31:535-47.^,66 Piccolo V, Moscarella E, Zalaudek I, Ferrara G, Picciocchi R, Ametrano O, et al. Analysis of clinical and dermoscopic features in melanocytic lesions with special emphasis on problematic lesions in children. Expert Rev Dermatol. 2013;8:155-70. PDN represents a benign nevus-associated cutaneous condition, and dermatologists should be aware of the existence of this skin disorder, whose recognition on the basis of clinical and dermoscopic features is important to avoid unnecessary excisions of melanocytic nevi with unusual appearance.

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