(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect the privacy of the child)
Abstract: A flesh-colored distributed linear hyperplasia, which was not painful and grew gradually over time, appeared on the arm area of a 2-year-old child, and his family was anxious and subsequently came to the hospital. After examination, it turned out to be a linear epidermal nevus caused by a genetic mutation, and symptoms were significantly relieved after active selection of treatment with retinoic acid cream. This disease is usually not contagious, and there is no obvious discomfort. After the appearance of epidermal symptoms, active medical consultation is recommended.
【Basic information】Female, 2 years old
Disease Type】Linear epidermal nevus
Hospital】Harbin Hospital of Traditional Chinese Medicine
Consultation date】May 2022
Treatment plan】Pathological examination + medication (vitamin A acid cream)
【Treatment Period】Home treatment for 15 days, review after 15 days
【Treatment effect】The linear growths on the skin surface gradually subsided
I. Initial consultation
In mid-May, a 30-year-old woman came into the clinic, holding a 2-year-old child in her arms. According to the mother’s description, she learned that the child’s right arm had developed flesh-colored hyperplasia in strips for unknown reasons 2 months ago, which grew gradually over time and eventually became striped at the elbow and shoulder. The child had no pain or itching, no crying mood, normal diet and normal bowel movements. On examination, the child was found to have flesh-colored strips on the anterolateral side of the right upper arm, with hyperplasia reaching up to the peak of the shoulder and down to the elbow, which were mildly raised and slightly hard to the touch, but did not show keratotic changes. The surface was smooth and no skin flakes were seen. Magnification revealed a dermatoglyphic surface with brown papules fused into creeping plaques. Based on the clinical presentation, the first reaction was a linear epidermal nevus, which was consistent with a unilateral distribution and a painless clinical presentation. We communicated with the family and explained the causes, clinical manifestations, and prognosis of epidermal nevus. After the child’s mother expressed her understanding, she agreed to perform dermatopathological tests to clarify the diagnosis. The pathological results showed that the epidermal hyperplasia of the skin mass involved the stratum corneum. Hyperkeratosis, hypertrophy of the spinous layer, and papillary hyperplasia were seen. The pathological results were consistent with the diagnosis of epidermal nevus, and combined with the clinical diagnosis of linear epidermal nevus.
II. Treatment process
After communicating with the child’s family, the treatment plan was clarified. After local anesthesia with lidocaine hydrochloride injection, a 0.3×0.5 cm skin patch was removed with a sharp knife, followed by one stitch of No. 3 silk suture and sterile dressing after iodine disinfection. The other parts are surgical areas, and topical retinoic acid cream is chosen for treatment. After being applied to the skin surface, it can accelerate the epidermal differentiation to a certain extent, which can make the skin damage of the formed linear epidermal nevus gradually shrink, thus achieving the purpose of eliminating the lesions. After the child’s family picked up the medication, they communicated with each other about the medication plan. The child’s family nodded that they had clarified the specific way of medication, and they were instructed to remove the stitches and follow up in 7 days.
Treatment effect
The child returned to the clinic 7 days later, and the sterile gauze was removed from the surgical site. The wound healed well, with no local redness or swelling, and no tearing of the wound after stitch removal. The symptoms had subsided.
IV. Precautions
After the treatment, the child’s adverse symptoms improved significantly, and we are truly happy for the child. Since there is an obvious local wound after taking the pathology of linear epidermal nevus, it is recommended that the wound site should not be exposed to water within 7 days, and a light diet is recommended before the wound is completely healed and improved, so as not to eat spicy and stimulating foods or seafood to avoid affecting the healing of the wound site. If redness and swelling appear in the area where the pathology is taken, it is recommended to seek medical attention promptly to avoid the formation of infection. Vitamin A acid drugs are mildly irritating to the skin, so the child is advised to follow the doctor’s instructions during the use of the drug and not to apply it excessively, a thin layer is sufficient.
V. Personal insight
Linear epidermal nevus is often inherited by autosomal dominant genes. The lesions can be single or multiple, varying in size, and appear as dense wart-like papules arranged in a linear pattern. Once diagnosed, the disease should be treated in a specialized hospital. The actual fact is that you can find a lot of people who are not able to get a good deal on this kind of things. The diet of these diseases is also more important, so the family should pay attention to the child’s daily life eating habits. During the follow-up, the doctor should also ask the child in detail about the state of daily life so as not to affect the recovery of the body.