Linear and whorled nevoid hypermelanosis in Infant/Neonate
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Synopsis

Linear and whorled nevoid hypermelanosis (LWNH) is a rare sporadic disorder in which multiple linear and swirled streaks of hyperpigmentation appear along lines of Blaschko without a preceding inflammatory stage. The hyperpigmentation typically becomes apparent soon after birth and remains stable, though it may progress for 1-2 years before stabilizing. Although originally described in 1988 in patients with only cutaneous findings, there have been several subsequent cases of LWNH with various systemic anomalies in the neurologic, cardiac, and musculoskeletal systems. The largest case series of patients with LWNH found a 30% incidence of extracutaneous abnormal features, primarily neurologic in nature.
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.
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.
Codes
ICD10CM:
L81.8 – Other specified disorders of pigmentation
SNOMEDCT:
403803002 – Linear and whorled nevoid hypermelanosis
L81.8 – Other specified disorders of pigmentation
SNOMEDCT:
403803002 – Linear and whorled nevoid hypermelanosis
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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
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References
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Last Updated:01/19/2022