Nevus comedonicus with epidermolytic hyperkeratosis. A report of four cases

Hypercornification is an early feature of acne and usually precedes inflammation. It is associated with ductal hyperproliferation, and there are many controlling factors such as androgens, retinoids, sebum composition and cytokines. Cycling of normal follicles and of comedones may explain the natural resolution of comedones and, in the longer term, resolution of the disease itself. There is a need to tailor treatment according to comedonal type. Suboptimal therapy can often result from inappropriate assessments of comedones, especially microcomedones, sandpaper comedones, submarine comedones and macrocomedones. Macrocomedones can produce devastating acne flares, particularly if patients are inappropriately prescribed oral isotretinoin. Gentle cautery under topical local anaesthesia is a useful therapy in the treatment of such lesions. The newer retinoids and new formulations of all-trans-retinoic acid show a better benefit/risk ratio.

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“…These are rare and may present before puberty but more often at and around puberty [37, 38]. The lesions may be typical confluent comedones (fig.…”

Section: Comedonal Typesmentioning

confidence: 99%

Comedogenesis: Some Aetiological, Clinical and Therapeutic Strategies

et al. 2003

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“…These are rare and may present before puberty but more often at and around puberty 37,38 . The lesions may be typical confluent comedones or whiteheads, usually occurring asymmetrically.…”

Section: Comedonal Typesmentioning

confidence: 99%

Comedogenesis: some new aetiological, clinical and therapeutic strategies

Cunliffe

Holland

Clark

et al. 2000

British Journal of Dermatology

140

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Hypercornification is an early feature of acne and precedes inflammation. It is associated with ductal hyperproliferation and there are many controlling factors such as androgens, retinoids and cytokines. Cycling of normal follicles and of comedones may explain the natural resolution of comedones and, in the longer term, resolution of the disease itself. There is a need to tailor treatment according to comedonal type. Suboptimal therapy can often result from inappropriate assessments of comedones, especially microcomedones, missed comedones, sandpaper comedones, submarine comedones and macrocomedones. Macrocomedones can produce devastating acne flares, particularly if patients are inappropriately prescribed oral isotretinoin. Gentle cautery under topical local anaesthesia is a useful therapy in the treatment of such lesions. The newer retinoids and new formulations of all-trans-retinoic acid show a better benefit/risk ratio. Evidence-based studies are required to allow adequate comparisons.

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“…Occurrence of EH in other dermatoses Bullous ichthyosiform erythroderma [7,8] Nevus unius lateris [9,10] Ichthyosis hystrix [10] Keratoderma palmariset plantaris [11] Solitary epidermolytic acanthoma [12] Disseminated epidermolytic acanthoma [13,14] Epidermolytic leukoplakia [15,16] Acrosyringial epidermolytic papulosis neviformis [17] I ncidental finding in a variety acquired solitary skin le sions [18,19] but also in the sebaceous ducts, and was as sociated with dyskeratotic cells and corps ronds in some specimens. Barsky et al [4] reported this variety of nevus comedonicus in 4 patients, 1 of whom had been previously described by Montgomery [20]. In 2 of these cases, the lesions had a linear distribution, in the other 2 they were extensive.…”

Section: Discussionmentioning

confidence: 92%