Dermal melanocytosis =التملن الأدمي |
Dermal melanocytosis Mongolian spot refers to a macular blue-gray pigmentation usually on the sacral area of healthy infants. Mongolian spot is usually present at birth or appears within the first weeks of life. Mongolian spot typically disappears spontaneously within 4 years but can persist for life.
PathophysiologyMongolian spot is a congenital, developmental condition exclusively involving the skin. Mongolian spot results from entrapment of melanocytes in the dermis during their migration from the neural crest into the epidermis. This migration is regulated by exogenous peptide growth factors that work by the activation of tyrosine kinase receptors. It is postulated that accumulated metabolites such as GM1 and heparan sulfate bind to this tyrosine kinase receptor and lead to severe neurologic manifestations and aberrant neural crest migration.
HistoryIn Mongolian spot, an asymptomatic bluish discoloration overlying the sacrococcygeal area is present at birth. Physical
CausesMongolian spot is a hereditary developmental condition caused by entrapment of melanocytes in the dermis during their migration from the neural crest into the epidermis.
Usually, laboratory studies are not indicated except when extensive Mongolian spots are present. In these circumstances, it is advisable to evaluate the patient for inborn errors of metabolism in order to avoid irreversible organ damage.19 Imaging StudiesIn extensive Mongolian spots involving the back, radiographic studies are needed to rule out a spinal meningeal tumor or anomaly. Histologic FindingsDendritic melanocytes with variably pigmented melanosomes typically are located in the deep reticular dermis. The melanocytes usually are oriented parallel to the epidermis. In contrast, the melanocytes in blue nevi are denser in number and more focally aggregated.
Medical CareOpaque cosmetics may be used as camouflage for Mongolian spots. Surgical CareThe value of lasers in Mongolian spot is uncertain. However, in a retrospective study of 26 Japanese patients, the Q-switched alexandrite laser showed better outcomes in extrasacral lesions treated at a younger age
Mongolian spots usually fade in the first year of life, but, at times, they may persist indefinitely. |