Eruptive collagenoma

Introduction

Connective tissue naevi are defind as hamartomas of dermal connective tissue components. Uitto et al have classified them according to the predominant element of extra cellular connective tissue, such as collagen, elastic fibres or proteoglycan and according to the inheritance pattern.[1] Connective tissue naevi in which collagen dominates are referred to as the Lipschutz type,while those in which elastic tissue changes are predominant are known as the Lewandowsky type.[2]

The hereditary types of connective tissue naevi include dermatofibrosis ventriculares disseminata in the Buschke Ollendroff syndrome, familial cutaneous collagenoma and shagreen patches in tuberous sclerosis.[3]

Case Report

A 42-year-old man presented with asymptomatic sudden eruption of skin-coloured nodules and plaques over back, abdomen, upper limb and face since 15 years. There was no history of trauma or syphilis in the past.

Examination revealed multiple skincoloured, firm non-tender nodules and plaques of variable sizes on back, abdomen, upper limb and face. Peau ′d orange appearance was noted in some nodules on pinching. Patient also had Beckers naevus present over the left side of chest.

Routine investigations were within normal limits. Blood VDRL was non reactive. X-ray of the pelvis was normal. Histopathology showed lobules of densely collagenized acellular connective tissue in the dermis insinuating between the dermal appendages and extending deeper towards the subcutis. The overlying epidermis was flattened at places due to the collagen pushing it up and acanthotic at others.Verhoeff Van Geison′s stain revealed marked reduction of elastic tissue and confirmed that the lobules of connective tissue were nothing but collagen. [Figure - 1]

Discussion

Eruptive collagenomas are acquired type of connective tissue naevi of collagen type and are referred to as Lipschutz type.[4] The dermal nodules seen in eruptive collagenoma are discrete, firm, skin - coloured, and slightly elevated. Some lesions have a Peau ′d orange surface. Lesions are symmetrically distributed over trunk and upper parts of arms.[5]

It differs from familial cutaneous collagenoma by absence of family history and from Buschke- Ollendroff syndrome by absence of osteopoikilosis;a benign disease of bone characterised by circumscribed areas of increased bone density especially in long and flat bone.

Becker′s neavus have been reported to be associated with connective tissue neavi.[6] The case reported here has clinical and histopathological features of eruptive collagenoma with involvement of face (which is not reported) and associated with Beckers naevus.