Epidermodysplasia verruciformis (EV) manifests early in childhood as pityriasis versicolor (PV)-like macules on sun-exposed sites such as the face. These hypopigmented lesions closely resemble commoner pediatric dermatoses such as PV or pityriasis alba. In this report of two cases, we describe the distinguishing dermoscopic features of PV-like macules in EV. Unfocused dotted vessels in a hypopigmented or erythematous background with whitish scales and pigment diluted vellus hairs on dermoscopy should raise the suspicion of EV in children presenting with PV-like lesions.
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A 50-year-old man presented with a 3-month history of asymptomatic erythrocyanotic patches on the chest with reactive left axillary lymphadenopathy (a). Skin biopsy showed a dermal vascular proliferation with lymphomononuclear infiltrates and 2 weeks later the patient developed a left-sided pleural effusion of exudative type (b). Contrast-enhanced computed tomography revealed a lytic lesion on the left eighth rib (c), which was confirmed by immunohistochemistry to be solitary plasmacytoma. Adenopathy and extensive skin patch overlying a plasmacytoma (AESOP) syndrome, 1 appears to be a paraneoplastic cutaneous vascular response to the cytokine release from underlying plasmacytoma. While pleural effusion is a recognized feature of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome, we demonstrate that it can also be associated with AESOP syndrome.
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