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Linear and whorled nevoid hypermelanosis in Adult
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Linear and whorled nevoid hypermelanosis in Adult

Contributors: Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH, Nancy Esterly MD
Other Resources UpToDate PubMed

Synopsis

Linear and whorled nevoid hypermelanosis is a sporadic disorder of asymmetric hyperpigmentation in a streaky or swirl-like pattern. It is also referred to as pigmentary mosaicism. The hyperpigmentation is present at birth or within the first few weeks of life and is not preceded by any other eruptions in the skin. The pigmentation may become more evident over the first few years of life, then stabilizes, and only rarely fades.

In the minority of cases, associated anomalies have been detected involving the central nervous and musculoskeletal systems as well as ocular and other abnormalities.

This disorder most likely represents a mosaic population of neuroectodermal cells, resulting in 2 distinct populations of skin cells having different colors.

Both the pigmentary and systemic findings are thought due to genetic mosaicism, with mutations in various genes leading to the variety of phenotypes observed. Mosaicism for c-KIT ligand (KITLG) in the hyperpigmented affected skin has been detected in one well-studied case.

For more information, see OMIM.

Codes

ICD10CM:
L81.8 – Other specified disorders of pigmentation

SNOMEDCT:
403803002 – Linear and whorled nevoid hypermelanosis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Incontinentia pigmenti (IP) – The third stage of IP shows hyperpigmented streaks in a Blaschko-like pattern, though typically there are preceding vesiculobullous and verrucous stages. IP is lethal in males due to an X-linked dominant inheritance. The mother should be examined.
  • Hypomelanosis of Ito (HI) – Typically presents at or soon after birth with hypopigmentation along lines of Blaschko, though there may concurrent hyperpigmentation. HI is also associated with extracutaneous anomalies.
  • Linear epidermal nevus
  • Albright syndrome

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated:02/26/2020
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Linear and whorled nevoid hypermelanosis in Adult
Linear and whorled nevoid hypermelanosis : Brown color, Hyperpigmented patch, Linear configuration, Primarily truncal distribution, Whorled configuration
Clinical image of Linear and whorled nevoid hypermelanosis
Linear and patterned brown patches in a blaschkoid distribution on the leg.
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