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| CASE REPORT |
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| Year : 1991 | Volume
: 57
| Issue : 5 | Page : 237-239 |
Penile nevus comedonicus
A Ghorpade, C Ramanan
,
Correspondence Address:
A Ghorpade
Three male patients with nevus comedonicus lesions confined to the penis are reported. The diagnosis was confirmed by clinical features and histopathology in all three cases. Topical retinoic acid cream was of no use in two cases.
Keywords: Penile nevus comidonicus
How to cite this article:
Ghorpade A, Ramanan C. Penile nevus comedonicus. Indian J Dermatol Venereol Leprol 1991;57:237-9 |
Nevus comedonicus is an uncommon developmental anomaly presenting as multiple grouped or discrete keratinous plugs blocking the pilosebaceous orifices. The lesions are sometimes present at birth but usually appear during childhood or adolescence. It affects both the sexes equally.[1] Usually the lesions are localised and have a linear or zosteriform distribution, but rarely extensive bilateral involvement has also been described[2] The occurrence of nevus comedonicus on palms, soles and glans penis[3],[4],[5] goes against the assumption of its pilosebaceous origin. It has been suggested that nevus comedonicus may be a variant of epidermal nevus[6],[7]. Lesions locaiised over the penis have been described only once[5].To the best of our knowledge, this is second report of such cases and first from India which we prefer to call "penile nevus comedonicus".
| Case Reports | |  |
Case 1
A 32-year-old male presented with the complaints of skin lesions over the penis of two years duration. These lesions used to enlarge, collect purulent material and used to rupture on their own off and on, leading to scar formation. There was no history of any local application. Cutaneous examination revealed multiple grouped small, pin head sized, papular lesions with keratinous plugs and superficial scarring over the penile shaft [Figure - 1]. No similar lesions were observed anywhere else. Histopathological examination from one of the papules revealed large horny plugs which had distended the pilosebaceous follicles. Retinoic acid cream 0.05% locally did not offer any relief after use for eight weeks.
Case 2
A 23-year-old male reported to us with the history of small blackish dot-like lesions on the glans penis of three years duration. On cutaneous examination multiple small pinpoint comedones were seen over the inner prepuce and coronal sulcus. No other skin lesions were seen. Biopsy from one of the comedones showed pilosebaceous orifices filled with horny plugs. He was asked to use retinoic acid cream 0.05% topically but subsequently lost for follow up.
Case 3
A 19-year-old male patient presented with the complaint of multiple lesions on his penis of one year duration. The lesions used to enlarge with purulent material and rupture leading to scar formation. On cutaneous examination, multiple comedones were seen over the distal half of the penile shaft. There were several scar marks over the penis. No comedones were seen anywhere else. Histopathological examination from one of the comedones revealed large horny plugs distending the pilosebaceous follicles [Figure - 2].
Topical retinoic acid cream 0.05% was discontinued when there was no improvement in six weeks.
| Comments | | |
The common sites involved in nevus comedonicus are the face, neck, upper arm, chest and abdomen. The area involved may be as little as 2 cms or as extensive as half of the trunk, the lesions usually show little tendency to extension but may be complicated by the formation of pustules, abscesses and scarring[1]. The histopathological findings of hair shafts" and sebaceous gland lobules[9] from nevus comedonicus lesions indicate that it is a developmental anomaly of pilosebaceous apparatus with the resulting structure being unable to produce hair and forming keratin only[10]
Regarding occurrence of lesions on non-hairy areas wood and Thew[5] suggested that in nevus comedonicus, there is a defect or failure in the development of the mesodermal component of the pilosebaceous complex with coincident imperfect differentiation of the epithelial component. According to them, nevus comedonicus is a hamartoma. Nabai and Mehregan[11] considered it to be a simple malformation of pilosebaceous structures. However Marsden et al[12] opined that the palmar lesions in their patient developed from abnormal sweat ducts. Barsky[6] opined that nevus comedonicus is a variant of epidermal nevus involving the hair follicle. Their patients showed microscopic changes of epidermolytic hyperkeratosis in their follicular epithelial walls. Kim and Kang[7] reported the association of nevus comedonicus with an epidermal nevus. According to them this association, and the scanning electron microscopic findings of chrysanthemum like keratotic plugs in the comedones and the surrounding epidermal nevus, suggest that nevus comedonious may be an uncommon from of epidermal nevus.
| References | | |
| 1. | Rook A : Naevi and other development defects, in: Test-book of Dermatology 3rd ed. Blackwell, London, 1979; 170.  |
| 2. | Beck MH and Dave VK: Extensive nevus comedonicus. Arch Dermatol, 1980; 116 :1048-50. |
| 3. | Wood MG and Thew MA: Nevus comedonicus : a case with palmar involvement and review of literature. Arch Dermatol, 1968; 98 : 111-6. |
| 4. | Harper KE and Spielovogel RL: Nevus comedonicus of the palm and wrist, J Amer Acad. De<<' tol, 1985; 12: 185-8. |
| 5. | Abdel Aal H and Abdel Aziz AHM: Nevus comedonicus (report of three cases localised on glans penis), Acta Dermatol Venereol (Stockholm), 1975; 55: 78-80. |
| 6. | Barsky S, Doyle JA and Winkelmann RK : Nevus comedonic- with epidermolytic hyperkeratosis, Arch Dermatol, 1981;117:86-8. |
| 7. | Kim SC and Kang WH. Nevus comedonicus associated with epidermal nevus. J Amer Acad Dermatol, 1989; 21: 1085-8. |
| 8. | Fritsch P and Wittels W: Ein Fall von bilateralem Naevus comedonicus, Hautarzt, 1971; 22: 409-12 quoted by, 7. |
| 9. | Paige TN and Mendelson CG: Bilateral nevus comedonicus, Arch Dermatol, 1967; 96:172-5. |
| 10. | Blanchard L, Hodge SJ and Owen LG: Linear eccrine nevus with comedones, Arch Dermatol, 1981; 117 : 357-9. |
| 11. | Nabai H and Mehregan AH : Nevus comedonicus (a review of literature and report of Twelve cases) : Acta Dermato Venereol (Stockholm), 1973; 53 71-4. |
| 12. | Marsden RA, Fleming K and Dawber RPR. Comedo naevus of the palm - a sweat duct naevus, Brit J Dermatol, 1979; 101 : 717-22. |
Figures
[Figure - 1], [Figure - 2]
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