Berloque dermatitis is linked to the upgrading of melanogenesis induced by ultraviolet rays thanks to psoralenic substances contained in perfume bergamot oil and sterilization products. The drainage of the photosensitizing fluid gives rise to bizarre dermatitis, sometimes simulating a jewel (2), first erythematous and then hypermelanic. Despite the widespread presence of these substances, dermatitis is rare for the variability of exogenous factors (applied quantity, intensity and duration of exposure, presence of epidermal lesions) and individual susceptibility (1). The wavelength involved in dermatitis pathogenesis is greater than 320 nanometers. Acute dermatitis can go unnoticed in the presence of other dermatological problems as in the present case. The duration of the chronic pigmentary phase is also very variable.
Fixed drug eruption is a disease that has a definite cause often identified with the history, with oral provocation tests or according to some Authors with patch tests (1); however, its pathogenesis is not clear. The cause is always a drug, although sometimes foods seem to play a causal role; however, in some of these cases the foods were contaminated with drugs (2). The most frequently involved drugs are non-steroidal anti-inflammatory drugs, sulfonamides and barbiturates. However, with changing therapeutic habits we noticed that the ability to cause fixed drug eruption was not the same for different drugs. In Italy up to 20 years ago the most widely used anti-inflammatory drug was feprazone; it was frequently responsible for fixed drug eruption in children; when feprazone was replaced by acetaminophen fixed drug eruption got exceptional in children.
Alterations of the color and texture of the hair can be be due to various hereditary, nevic and acquired causes (1). The lesion we describe in this report due to its band distribution resembles the baby’s telogen effluvium. However, the latter is physiological and transient, found in the first months of life on the median line and characterized by the absence of hair due to synchronous hair loss as is the case in fetal life (2). Due to its position in the occipital region in the past it was mistakenly attributed to the rubbing of the baby’s head on the pillow. The present lesion is moreover characterized by thinner and hypopigmented hair as occurs in the so-called congenital triangular alopecia, a condition that can also be highlighted after birth. In the latter condition the hair is thin enough to give the impression that we are dealing with alopecia and not with a hypotricotic nevus as it is today accepted by all (4). The lesion we describe here, however, has a segmental, asymmetric band distribution. This type of distribution suggests a nevus condition due to skin mosaicism and is similar to another nevus condition, hair band heterochromia (1, 6, 7). In this condition the hair band of lighter color, for instance blond in a subject with dark hair, is thinner (7) or of the same thickness as the darkest ones (1). All the reports that talk about this affection so similar to the condition we here describe believe that the horizontal bands of lighter hair is the expression of a post-zygotic mutation: this would give rise to a keratinocyte clone that spreads along the Blaschko lines of the scalp (5).
There are only two papers in the literature reporting lesions similar to those here described (1, 2). In one of these reports (1) the Mongolian spot is present at birth; the café au lait spots arise after one month and at the periphery of all spots standing on the Mongolian spot appears a normal skin halo. It seems clinically that the Mongolian spot disappears around the café au lait spot. The Authors decided and managed to make 3 biopsies, 1 on the Mongolian spot, 1 on the halo and 1 on the café au lait spot, showing that the dermal melanocytes present in the halo area and those in the café au lait spot were different from those found in the dermis corresponding to the Mongolian spot. They were round, had no dendrites, had little melanin in the absence of any inflammatory phenomenon.
Pigment reoccurrence inside a white cutaneous stain can occur with different mechanisms. Characteristically, in piebaldism round, large islands of normal or accentuated pigmentation appear; their appearance seems to be independent of sun exposure (1). In nevus depigmentosus lesions reminiscent of lentigines may occur as a result of reverse mutation (2). A follicular repigmentation, that is, a progressive melanocyte repopulation of the epidermis basal layer starting from the hair follicle melanocytes, occurs in vitiligo, especially in the perinevic and segmental forms that more easily tend to regress as compared with systemic vitiligo. On the other hand, to the best of our knowledge a follicular repigmentation of a white macula of tuberous sclerosis complex has never been described so far in the relevant literature.
The diagnosis of neurofibromatosis type 1 (NF1) is difficult in infancy when it is necessary to differentiate it from more frequent conditions such as hypermelanic nevus and rarer ones such as McCune-Albright syndrome. This is a retrospective clinical study that examines the frequency of known diagnostic criteria as plexiform neurofibroma and conditions such as juvenile xanthogranuloma that, although not yet considered a diagnostic criterion, greatly reinforce the suspicion of NF1. In a population of 94 children with café au lait spots as a sign of onset there was an affected parent in 4 cases, plexiform neurofibroma in 8 cases, juvenile xanthogranuloma in 9, nevus anemicus, dysmetry of a limb and congenital medium sized or giant melanocytic nevus respectively in 4 cases. Modalities of monitoring a baby with café au lait spots and suspected NF1 are suggested.
In the first months the baby often presents in the occipital region a band hair loss; according to the popular tradition it is attributed to the clutch on the pillow during supine lying, although being really due to the last synchronous wave of hair loss occurring during the fetal life. Band hypotrichotic nevus is on the other hand a much rarer condition characterized by a longer persistence.
The blister is a cavity full of fluid which protrudes on the skin. The layman calls blister even the white wheal of urticaria which is not a cavity. The latter is deeper and spontaneously regresses in a few minutes without any residua. However, the mistake of the layman is partially justified by the etymology, because pomphus and pemphigus, which is the most common autoimmune bullous disorder, have the same root. The blister is larger than the vesicle and can be easily seen. On the other hand, the vesicle is rarely visible, except for particular cases and sites. (...).
The report of Romiti et Al., in this issue of the Journal, should be discussed for two reasons as follows: 1- the definition of the hyperpigmented macules which are present from the first period of life and 2- the more general problem of the association between skin and other organs malformations (...).