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Differential Diagnosis
Published in Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan, Comprehensive Textbook on Vitiligo, 2020
Hemant Kumar Kar, Gunjan Verma
Nevus anemicus also presents as a depigmented lesion, a common mimicker of vitiligo, especially in children. The underlying mechanism is an aberrant, hypersensitive response to catecholamines resulting in pallor of the skin. Hence it has been called a pharmacological nevus. The lesion is well defined and has an irregular border. When the skin in these lesions is rubbed, no red coloring is observed as there is no vasodilatation possible. Nevus anemicus on diascopy merges with the surrounding skin and is not accentuated. Woods light does not accentuate it, as it lacks any underlying pigmentary abnormality (Figure 16.1), and because of locally increased vascular reactivity to catecholamines, this simple bedside test can easily help the clinician to differentiate between the two nevi anemici that may occur on the neck and trunk of young children with neurofibromatosis when other features have not yet developed. It can also be observed in tuberous sclerosis (TSC) or as one component of phacomatosis pigmentovascularis.
Cutis marmorata telangiectatica congenita: a focus on its diagnosis, ophthalmic anomalies, and possible etiologic factors
Published in Ophthalmic Genetics, 2020
Matthew S. Elitt, Joan E. Tamburro, Rocio T. Moran, Elias Traboulsi
Several disorders can possess CMTC-like features, including Trisomy 21, Trisomy 18, Cornelia de Lange syndrome, and Divry-Van Bogaert syndrome (9). While these syndromes display unambiguous, disease-defining features that allow for straightforward identification and diagnosis, several other disorders can exhibit considerable symptom overlap with CMTC, including Adams-Oliver syndrome, Bockenheimer’s syndrome, Klippel-Trenaunay syndrome, megalencephaly–capillary malformations, neonatal lupus erythematous, phacomatosis pigmentovascularis type V, physiologic cutis marmorata, and Sturge-Weber syndrome. Correct discrimination of these various disorders from CMTC necessitates careful adherence to disease-specific diagnostic criteria, including disease-defining genetic and clinical features (Table 2). A more holistic description of CMTC’s clinical findings, including rarer disease manifestations, would likely enhance the identification and diagnosis of this disorder. Additionally, a complete appreciation of these rarer findings may prevent secondary sequalae related to these pathologies.
Cutis mormorata telangiectatica congenital successfully treated with intense pulsed light therapy: A case report
Published in Journal of Cosmetic and Laser Therapy, 2018
CMTC is a very rarely reported congenital vascular anomaly present at birth. Since the first case report by Von Lohuizen in 1922, more than 300 (3) cases have been reported worldwide to date. On reviewing the literature, it was found that there is no satisfactory treatment for this condition especially in ulcerative variety. Also cutis marmorata is a benign self-limiting condition and does not require treatment but in ulcerative variety because of severe pain life becomes miserable for the patient. There are reports of phakomatosis pigmentovascularis type II-associated CMTC responding to combination laser treatment using Q-switched Alexandrite and long-pulsed dye laser (3). On review of literature on IPL therapy in vascular anomalies, we found that IPL reduces the inflammation by downregulating TNF-alpha (4). IPL enhances transforming growth factor beta1/smad3 signaling pathway (5), thereby inducing synthesis of dermal extracellular proteins in vitro (6). IPL also increases the content of dermal collagen and elastic fibers (7). All these factors help in reducing the inflammation as well as reduction of scarring, which was evident in our results of the therapy. IPL does help in correcting the dilatation of capillaries (8) by using vascular filter of wavelength 550–1200 nm. IPL therapy was started in this vascular anomaly because histologically it showed classical dilatation of capillaries in the dermis. IPL is also used in the erythematotelangiectatictype of rosacea (9,10,11) where it helps not only in reducing blood flow but also reduces the area of telangiectasia and thereby reducing erythema. It also helps in improving the skin texture. Schroeter and Neumann (12) and later on Angermeirer (13) and Bjerring et al. (14) confirmed the use of IPL in facial telangiectasias. Clementoni et al (15) reported 87% of patients showed 75–100% clearance in facial telangiectasia. With the help of these reviews on IPL in the treatment of telangiectasia, this technology was used in treating CMTC with excellent result (Figure 4c).