Cutaneous mastocytosis: clinical, dermoscopic and pathologic
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A 1.5 Y/O boy was brought by his parents with intermittently itchy, round to oval, yellowish to skin-coloured maculopapules on the trunk for the last 1 year. The lesions were about 0.5×1 cm in size and were present on the chest, abdomen and back. Stroking a lesion with a blunt object produced faint perilesional erythema with urtication. There were no systemic reports.

Clinical differential diagnosis of cutaneous mastocytosis (multiple mastocytomas) and juvenile xanthogranuloma were considered. Dermoscopy of a lesion revealed a central whitish area surrounded by a reticulate light brown rim on a yellowish background. A biopsy was taken for pathological examination, which revealed orthokeratotic epidermis with basal layer melanisation and diffuse infiltration by mastocytes in the superficial epidermis. A Giemsa stain demonstrated metachromatic mast cell granules.

Therefore, based on clinical and dermoscopic features and pathological findings, a diagnosis of cutaneous mastocytosis (multiple mastocytomas) was made. The patient was started on H1 antihistamines (syrup cetirizine 5 mg/5 mL, half teaspoonful at bedtime) which led to symptomatic improvement. The patient is on regular follow-up.

--Cutaneous mastocytosis typically presents within the first few months of birth but a later onset is not uncommon. The lesions may urticate on stroking (Darier’s sign).

--Dermoscopic features in cutaneous lesions of mastocytosis include a light brown rim, pigment network and yellow–orange blot.

--Pathological examination shows diffuse infiltration by mastocytes in the upper epidermis, which demonstrates metachromatic granules.

Source: https://casereports.bmj.com/content/13/12/e240169?rss=1
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