Involucrin in the differential diagnosis between linear psoriasis and inflammatory linear verrucous epidermal nevus: a report of one case.
Bottom Line: Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis.We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus.Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.
Affiliation: Federal University of São Paulo, EPM.
Inflammatory linear verrucous epidermal nevus is a variant of verrucous epidermal nevus, characterized by recurrent inflammatory phenomena. Despite well-established clinical manifestations, the differential diagnosis between inflammatory linear verrucous epidermal nevus and linear psoriasis remains difficult. Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis. We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus. Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.
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Mentions: A 4-year-old girl presented with numerous confluent verrucous papules, eitherhypochromic or erythematous, linearly distributed, some along the Blaschko's lines, onthe trunk, upper and lower limbs, since birth (Figure1). No other skin lesions, or ungueal, scalp or mucosal lesions were detected.Lesions were located initially in the back of the patient's right hand, withdissemination to the rest of trunk and limbs over the years. The lesions were pruritic.Her medical history suggested substantial reaction to food allergies. She had a twinsister without skin lesions and there was no family history of psoriasis or of any otherskin disorder. Given the clinical aspect, the diagnostic hypotheses were ILVEN,ichthyosis hystrix, linear psoriasis, incontinentia pigmenti and lichen striatus.Histopathologic examination revealed a psoriasiform dermatitis, consistent with theclinical hypothesis of ILVEN and linear psoriasis, and it was not possible todifferentiate between the two (Figure 2). Resultsof immunohistochemical staining for involucrin revealed that this protein expression wasincreased in the orthokeratotic regions but deficient in the parakeratotic regions(Figure 3). The patient received topicaltreatment with keratolytics and steroids, as well as systemic treatment withantihistaminic drugs. The treatments resulted in moderated improvement of the lesionsand pruritus.