Young woman with pregnancy-associated dermatosis

Abstract: 31 yo woman with atypical blood vessels on right arm and chest.
History: This healthy 31 yo woman has had an asymptomatic slowly progressive erythematous process on her right arm and shoulder. She is in her second trimester of pregnancy. The reddish areas are slowly getting more pronounced.
O/E: Mat-like telangiectasias on right arm and shoulder: Dermatomal distribution.
Clinical Photo(s):



Lab: N/A
Histopathology: N/A
Diagnosis: Unilateral Nevoid Telangiectasia
Questions:
Reason(s) Presented: For Interest. This is a benign entity, uncommonly encountered, but easy to recognize. The patient appreciates reassurance.
Reference: Unilateral nevoid telangiectasia (UNT) is a cutaneous condition consisting of congenital or acquired patches of superficial telangiectases in a unilateral linear distribution. Described in 1899 by Blaschko, its segmental pattern suggests a mechanism of somatic mosaicism apparent early in life or unmasked in states of relative estrogen excess, such as that in pregnancy or in chronic liver disease. Full Article

Retroauricular Dermatitis

Abstract: 16 yo boy with 3-4 year history of retroauricular dermatitis
History: This 16-year-old boy was seen for evaluation of a retroauricular dermatitis that has been present for 3-4 years. He is in his usual state of health. He does not have a history of atopy. He does not wear glasses.
O/E: Honey-colored crusting in the superior retroauricular sulci bilaterally.
Clinical Photo:

click image to enlarge
Lab: Culture positive for many Staph. aureus with usual sensitivities.
Histopathology: N/A
Diagnosis or DDx: Retroauricular Dermatitis: This is felt to be a marker for atopic dermatitis or atopy. However, this boy is not atopic and the finding may not be all that specific. Only one article has appeared on this subject (see Reference).
Questions: Does anyone have any comments on this entity?
Reason(s) Presented: For interest.
Treatment: The patient was given a sample tube of retapamulin ointment to use b.i.d. for one week. The next photo shows appearance after one week of use as monotherapy. I plan to now use fluocinalone 0.025% ointment daily for a week or two for the residual dermatitis. This may well recur. The natural history of retroauricular dermatitis is poorly defined. There is only one article in the medical literature that discusses this entity.

status post 0ne week of retapamulin ointment

References:
Marks MB, et. al. An unsuspected sign of cutaneous allergy. J Am Acad Dermatol. 1981 May;4(5):519-22.

An eczematous eruption in the superior retroauricular areas of the scalp and often
on the posterior aspects of the pinnas may be seen in about 30% of allergic
children. The eruption is not generally noticed because the overhanging hair covers
the affected areas. The dermatitis is seen mainly in those children afflicted with
bronchial asthma, perennial allergic rhinitis, or both. A previous history of atopic
or seborrheic dermatitis is, as a rule, not elicited.

Tuberous sclerosis

This 15-year old boy presented to my office with multiple asymptomatic papules on the face since age of three.

click on images to enlarge
Note the firm papulonodular lesions with a friable vascular surface distributed on the nose and right nasolabial fold. These lesions, called adenoma sebaceum, are actually angiofibromas - a form of cutaneous hamartoma. The patient has no neurological deficit, but tuberous sclerosis can affect many organ systems: heart, brain, kidney, liver and eyes. The lesions can be removed by light cautery and curettage or carbon dioxide laser therapy. The latter is more expensive and not much better.

A good review can be found on emedicine.com

Submitted by Henry Foong, Ipoh, Malaysia. Contact Dr. Foong.