A 50-year-old man presented with multiple asymptomatic, follicular, hyperpigmented macules of diameter 2–3 mm covering an area of 7 cm × 5 cm over the left side of the upper chest since adolescence [Figure 1]. There was no hypertrichosis, acneiform eruptions, skeletal deformity, or any other system involvement. No follicular pits, keratotic follicular papules, comedo-like papules, or any other features suggestive of follicular Dowling-Degos disease or sometimes associated reticulate hyperpigmentation as seen in Dowling-Degos disease, were present in our patient. None of the family members had similar lesions. A punch biopsy from one of the macules revealed the epidermis showing mild papillomatosis, acanthosis, and prominent basal cell melanization. interconnected and broad rete ridges were visible at places and the dermis was essentially normal [Figure 2]. A diagnosis of follicular Becker’s nevus was made based on clinical features confirmed by histopathology.
Figure 1.
Multiple discrete, follicular, hyperpigmented macules of diameter 2–3 mm covering an area of 7 cm × 5 cm over the left side of the upper chest
Figure 2.
The epidermis showing mild papillomatosis, acanthosis, and prominent basal cell melanization. The dermis was essentially normal (H and E, 100X) Inset: Fontana Masson stain highlighting the basal pigmentation
Follicular Becker’s nevus is a relatively newer variant. It has been described only recently in a case series of four patients with a short duration of mean 1.93 years.[1] The authors had speculated that with time, the follicular lesions might evolve into the classical lesions of Becker’s nevus.[1] Our patient had these lesions for about 35 years and the lesions remained exclusively follicular. This case of a rare variant of Becker’s nevus with a long history highlights the fact that this morphology is a distinct entity with no evolution into the classical form of Becker’s nevus.
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Reference
- 1.Manchanda Y, Khaitan BK, Ramam M, Das S, Al-Mutairi N. Follicular Becker's nevus: A new clinical variant. Indian J Dermatol. 2020;65:130–2. doi: 10.4103/ijd.IJD_476_18. [DOI] [PMC free article] [PubMed] [Google Scholar]