Nevus anemicus: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(13 intermediate revisions by 2 users not shown)
Line 9: Line 9:


==Overview==
==Overview==
'''Nevus anemicus''' is a congenital disorder characterized by hypopigmented macules of varying size and shape.<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. Page 582. ISBN 0-7216-2921-0.</ref><ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref> The hypopigmented area is due to the blood vessels within the area which are more sensitive to the body’s normal vasoconstricting chemicals, such as [[catecholamines]].<ref name="aocd">{{cite web |url=http://www.aocd.org/skin/dermatologic_diseases/nevus_anemicus.html|title=Dermatologic Disease Database |accessdate=25 October 2011}}</ref>
'''Nevus anemicus''' is a congenital disorder characterized by hypopigmented macules of varying size and shape.<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. Page 582. ISBN 0-7216-2921-0.</ref><ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref>


==Symptoms==
==Pathophysiology==
* This [[benign]] patch appears on the [[skin]] at birth or in early childhood. In most people these are under 10 cm in size.
The hypopigmentation is due to increased sensitivity of the blood vessels within the area to the body’s normal vasoconstricting chemicals, such as [[catecholamines]].<ref name="aocd">{{cite web |url=http://www.aocd.org/skin/dermatologic_diseases/nevus_anemicus.html|title=Dermatologic Disease Database |accessdate=25 October 2011}}</ref> The involved area is lighter than the normal skin, not because of a loss of pigment occurs, but because blood vessels are constricted, producing a permanent blanching of the area. This blanching is a functional rather than a structual abnormality, presumed to be caused by local increased sensitivity to [[catecholamine]]s.<ref name="Oski">McMillan , Julia A; DeAngelis, Catherine D.; Feigin, Ralph D.; Warshaw, Joseph B. (2006). ''Oski's Pediatrics, Principles & Practice''. (4th ed.). Page 458. ISBN 978-0-7817-1618-5.</ref>  Although the cutaneous [[Circulatory system|vasculature]] appears normal [[histologically]], the blood vessels within the nevus do not respond to injection of [[vasodilators]].
* If there is doubt about the diagnosis, rubbing the area causes the skin around the lesion to become red while the lesion itself does not change in color.<ref name="aocd"/>
 
==Differential Diagnosis==
*Nevus anemicus must be differentiated from [[vitiligo]] and other diseases causing [[hypopigmentation]].
*Rubbing the area causes the skin around the lesion to become red while the lesion itself does not change in color.<ref name="aocd"/>
*[[Diascopy]] is used to differentiate nevus anemicus from other hypopigmented skin lesions, such as [[vitiligo]].
*Results of a skin [[biopsy]] are often interpreted as normal unlike other conditions.
*Physiological testing can exacerbate the appearance of the nevus in contrast to normal skin. Normally, when the skin is stroked, normal skin would react with a characteristic [[erythematous]] response.  In nevus anemicus, stroking the patch elicits no red flare.
* Examination under a [[Wood's lamp#Clinical use|Wood lamp]] can also distinguish the patch form [[vitiligo]]. <ref name="Barber">Barber Kirk (2010). Consultant For Pediatricians '. Page 9:233, 237.</ref>
 
==Natural History, Prognosis, and Complications==
*The patch appears on the [[skin]] at birth or in early childhood and the lesion is benign.
 
==Physical Examination==
* In most people, the patches are under 10 cm in size.
* Often the patches are difficult to see against the background color of the patient’s skin, but if [[sunburn]] develops, then the white area stands out prominently.<ref>{{cite web |url=http://www.globalskinatlas.com/imagedetail.cfm?TopLevelid=682&ImageID=1775&did=182|title=Global Skin Atlas |accessdate=25 October 2011}}</ref>
* Often the patches are difficult to see against the background color of the patient’s skin, but if [[sunburn]] develops, then the white area stands out prominently.<ref>{{cite web |url=http://www.globalskinatlas.com/imagedetail.cfm?TopLevelid=682&ImageID=1775&did=182|title=Global Skin Atlas |accessdate=25 October 2011}}</ref>
* The involved area is lighter than the normal skin, not because of a loss of pigment occurs, but because blood vessels are constricted, producing a permanent blanching of the area. This blanching is a functional rather than a structual abnormality, presumed to be caused by local increased sensitivity to [[catecholamine]]s.<ref name="Oski">McMillan , Julia A; DeAngelis, Catherine D.; Feigin, Ralph D.; Warshaw, Joseph B. (2006). ''Oski's Pediatrics, Principles & Practice''. (4th ed.). Page 458. ISBN 978-0-7817-1618-5.</ref>
* Although the cutaneous [[Circulatory system|vasculature]] appears normal [[histologically]], the blood vessels within the nevus do not respond to injection of [[vasodilators]]. It has been postulated that the persistent pallor may represent a sustained localized adrenergic [[vasoconstriction]].<ref name="Nelson">Nelson Textbook of Pediatrics 19th. (10th ed.). W.B. Saunders Company. Page 640. ISBN 1-4377-0755-6.</ref>
* [[Diascopy]] is used to differentiate from other hypopigmented skin lesions, such as [[vitiligo]].
* Results of a skin [[biopsy]] would be interpreted as normal and only physiological testing can reveal the nevus in contrast to normal skin. Stroking the patch elicits no red flare. Only the normal skin would react with a characteristic erythematous response.
* Examination under a [[Wood's lamp#Clinical use|Wood lamp]] can also reveal the nevus anemicus patch will not emphasize as a patch of [[vitiligo]] would.<ref name="Barber">Barber Kirk (2010). Consultant For Pediatricians '. Page 9:233, 237.</ref>


==Treatment==
==Treatment==
Since the [[histopathology]] of nevus anemicus is normal, nevus anemicus is a [[pharmacologic]] nevus and not an [[anatomic]] one.<ref name="Mountcastle">Mountcastle EA, Diestelmeier MR, Lupton GP. Nevus anemicus. J Am Acad Dermatol 1986;14:628-32..</ref><ref name="Requena">Requena L, Sangueza OP. Cutaneous vascular anomalies. Part 1. Hamartomas, malformations and dilation of preexisting vessels. J Am Acad Dermatol 1997;37:523-49,quiz 549-52.</ref> In most people a nevus anemicus is on a covered area and so light in appearance that no treatment is needed.<ref name="aocd"/>
Since the [[histopathology]] of nevus anemicus is normal, nevus anemicus is a [[pharmacologic]] nevus and not an [[anatomic]] one.<ref name="Mountcastle">Mountcastle EA, Diestelmeier MR, Lupton GP. Nevus anemicus. J Am Acad Dermatol 1986;14:628-32..</ref><ref name="Requena">Requena L, Sangueza OP. Cutaneous vascular anomalies. Part 1. Hamartomas, malformations and dilation of preexisting vessels. J Am Acad Dermatol 1997;37:523-49,quiz 549-52.</ref> In most people a nevus anemicus is on a covered area and so light in appearance that no treatment is needed.<ref name="aocd"/>
==Gallery==
<small> Image obtained from Dermatology Atlas<ref>{{cite web| title= Dermatology Atlas, created by Samuel Freire da Silva, M.D. | url=(http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=313) </ref></small>
<gallery> Image:Nevus Anemicus.jpg
Image:Nevus Anemicus 2.jpg
Image:Nevus Anemicus 3.jpg</gallery>


== See also ==
== See also ==
Line 33: Line 47:


[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Pigment Disorders]]
[[Category:Pigment disorders]]
[[Category:Skin Diseases]]
[[Category:Skin diseases]]


{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}

Latest revision as of 22:35, 26 June 2014

Nevus anemicus
Left leg with nevus anemicus patches.

WikiDoc Resources for Nevus anemicus

Articles

Most recent articles on Nevus anemicus

Most cited articles on Nevus anemicus

Review articles on Nevus anemicus

Articles on Nevus anemicus in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Nevus anemicus

Images of Nevus anemicus

Photos of Nevus anemicus

Podcasts & MP3s on Nevus anemicus

Videos on Nevus anemicus

Evidence Based Medicine

Cochrane Collaboration on Nevus anemicus

Bandolier on Nevus anemicus

TRIP on Nevus anemicus

Clinical Trials

Ongoing Trials on Nevus anemicus at Clinical Trials.gov

Trial results on Nevus anemicus

Clinical Trials on Nevus anemicus at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Nevus anemicus

NICE Guidance on Nevus anemicus

NHS PRODIGY Guidance

FDA on Nevus anemicus

CDC on Nevus anemicus

Books

Books on Nevus anemicus

News

Nevus anemicus in the news

Be alerted to news on Nevus anemicus

News trends on Nevus anemicus

Commentary

Blogs on Nevus anemicus

Definitions

Definitions of Nevus anemicus

Patient Resources / Community

Patient resources on Nevus anemicus

Discussion groups on Nevus anemicus

Patient Handouts on Nevus anemicus

Directions to Hospitals Treating Nevus anemicus

Risk calculators and risk factors for Nevus anemicus

Healthcare Provider Resources

Symptoms of Nevus anemicus

Causes & Risk Factors for Nevus anemicus

Diagnostic studies for Nevus anemicus

Treatment of Nevus anemicus

Continuing Medical Education (CME)

CME Programs on Nevus anemicus

International

Nevus anemicus en Espanol

Nevus anemicus en Francais

Business

Nevus anemicus in the Marketplace

Patents on Nevus anemicus

Experimental / Informatics

List of terms related to Nevus anemicus

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Nevus anemicus is a congenital disorder characterized by hypopigmented macules of varying size and shape.[1][2]

Pathophysiology

The hypopigmentation is due to increased sensitivity of the blood vessels within the area to the body’s normal vasoconstricting chemicals, such as catecholamines.[3] The involved area is lighter than the normal skin, not because of a loss of pigment occurs, but because blood vessels are constricted, producing a permanent blanching of the area. This blanching is a functional rather than a structual abnormality, presumed to be caused by local increased sensitivity to catecholamines.[4] Although the cutaneous vasculature appears normal histologically, the blood vessels within the nevus do not respond to injection of vasodilators.

Differential Diagnosis

  • Nevus anemicus must be differentiated from vitiligo and other diseases causing hypopigmentation.
  • Rubbing the area causes the skin around the lesion to become red while the lesion itself does not change in color.[3]
  • Diascopy is used to differentiate nevus anemicus from other hypopigmented skin lesions, such as vitiligo.
  • Results of a skin biopsy are often interpreted as normal unlike other conditions.
  • Physiological testing can exacerbate the appearance of the nevus in contrast to normal skin. Normally, when the skin is stroked, normal skin would react with a characteristic erythematous response. In nevus anemicus, stroking the patch elicits no red flare.
  • Examination under a Wood lamp can also distinguish the patch form vitiligo. [5]

Natural History, Prognosis, and Complications

  • The patch appears on the skin at birth or in early childhood and the lesion is benign.

Physical Examination

  • In most people, the patches are under 10 cm in size.
  • Often the patches are difficult to see against the background color of the patient’s skin, but if sunburn develops, then the white area stands out prominently.[6]

Treatment

Since the histopathology of nevus anemicus is normal, nevus anemicus is a pharmacologic nevus and not an anatomic one.[7][8] In most people a nevus anemicus is on a covered area and so light in appearance that no treatment is needed.[3]

Gallery

Image obtained from Dermatology Atlas[9]

See also

References

  1. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 582. ISBN 0-7216-2921-0.
  2. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
  3. 3.0 3.1 3.2 "Dermatologic Disease Database". Retrieved 25 October 2011.
  4. McMillan , Julia A; DeAngelis, Catherine D.; Feigin, Ralph D.; Warshaw, Joseph B. (2006). Oski's Pediatrics, Principles & Practice. (4th ed.). Page 458. ISBN 978-0-7817-1618-5.
  5. Barber Kirk (2010). Consultant For Pediatricians '. Page 9:233, 237.
  6. "Global Skin Atlas". Retrieved 25 October 2011.
  7. Mountcastle EA, Diestelmeier MR, Lupton GP. Nevus anemicus. J Am Acad Dermatol 1986;14:628-32..
  8. Requena L, Sangueza OP. Cutaneous vascular anomalies. Part 1. Hamartomas, malformations and dilation of preexisting vessels. J Am Acad Dermatol 1997;37:523-49,quiz 549-52.
  9. {{cite web| title= Dermatology Atlas, created by Samuel Freire da Silva, M.D. | url=(http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=313)


Template:WikiDoc Sources