Nevus Comedonicus with Epidermolytic Hyperkeratosis: A Case Report

Area of Science:

• Dermatology
• Dermatopathology
• Medical Case Reports

Background:

• Nevus comedonicus (NC) is a rare follicular developmental anomaly, typically presenting in childhood.
• While often isolated, NC can be associated with nevus comedonicus syndrome, involving systemic abnormalities.
• Co-occurrence of epidermolytic hyperkeratosis (EHK) with NC is exceptionally uncommon.

Observation:

• A healthy 27-year-old female presented with asymptomatic, unilateral, linear lesions on her trunk and limbs.
• Lesions developed over a decade, exhibiting a characteristic linear pattern.
• The patient had no reported gender or racial predilection, nor any systemic symptoms.

Findings:

• Histopathological examination revealed dilated follicular ostia consistent with NC.
• Key findings included orthokeratotic hyperkeratosis, parakeratosis with cornoid flagellation, and epidermolytic hyperkeratosis (EHK).
• Mild acanthosis was noted on the follicular wall.

Implications:

• This case expands the clinical spectrum of nevus comedonicus, particularly its late-onset presentation.
• The concurrent finding of EHK in adult NC suggests potential, albeit rare, associations that warrant further investigation.
• Highlights the importance of histopathological correlation in diagnosing atypical presentations of follicular nevi.