The epidermal nevus is a malformation of the skin that originates from the melanocytes. The abnormality is benign and is also known as a birthmark. In the case of cosmetic impairment, an excision can take place.
What is an epidermal nevus?
Nevus are circumscribed skin and mucosal malformations of a benign nature and mostly originate from the pigment-producing melanocytes. Brownish colored nevi of the melanocytes are also known as pigment nevi. Colloquially, one speaks of birthmarks or moles.
Moles of the epidermis are known as epidermal nevi. The epidermis corresponds to the uppermost, keratinizing skin epithelial layer and carries neither nerves nor vessels. Epidermal nevi usually manifest themselves in the form of streaky, often brownish thickenings of this skin layer. This is usually accompanied by hyperkeratosis, i.e. keratinization of the squamous epithelium.
According to HOWSMB, the epidermal nevus shows a high prevalence. Instead of the spelling “nevus”, the medical literature also uses the spelling “nevus”. The so-called epidermal nevus syndrome (ENS) must be distinguished from the epidermal nevus in the form of an isolated phenomenon.
It is about the association of epidermal nevi with developmental disorders of the nerves, skeleton, urogenital tract and cardiovascular system. Various sub-forms of the epidermal nevus exist, some of which are associated with other syndromes.
Causes
Epidermal nevi usually originate from the melanocytes. These are the pigment-forming cells of the skin, which are mainly found in the epidermal basal cell layer. The cells produce melanin, which absorbs teratogenic UV radiation and protects the deeper layers of the skin from degeneration.
Melanin production is primarily related to the level of the melanocyte-stimulating hormone. It is a breakdown product of Proopiomelanocortin. Vitamin D metabolites and stimuli such as UV radiation also play a role in production. Birthmarks can be congenital or acquired.
The causes of congenital epidermal nevi have not yet been conclusively clarified. A genetic predisposition is assumed for both congenital and acquired forms of epidermal nevus. Also disorders of the immune system and environmental factors or hormonal causes are discussed as causative factors for nevi. The formation of birthmarks is always a complex process that is characterized by internal factors such as genetic predisposition and is favored by various external factors.
Symptoms, ailments & signs
Epidermal nevi can be present from birth. Usually they develop in childhood at the latest. The epidermal nevus is sharply demarcated and manifests itself as a cobblestone-like, scaly or verrucous thickening of the epidermal skin layer. Itching has been reported in isolated cases.
Different forms of epidermal nevus are distinguished. The circumscribed variant corresponds to a soft, streaky, verrucous change in the skin. This variant is more commonly associated with itching than the other variants. A well-known form of epidermal nevus is also the purely verrucous form, which is associated with signs of inflammation.
In addition to pruritus, this variant can lead to a linear or unilateral systemic spread of the skin changes. This form occurs almost exclusively in childhood. It usually spreads at a slow rate. In isolated cases, nail dystrophy has been observed in patients with this type of epidermal nevus.
Diagnosis
The diagnosis of an epidermal nevus is first made by visual diagnosis. With congenital forms, the skin abnormality is noticeable immediately after birth. Most often, however, epidermal nevi are diagnosed in childhood. Like all other birthmarks, the malignancy of the changes must be ruled out by means of a histology.
In terms of differential diagnosis, psoriasis and licher ruber must be considered in particular. Histopathologically, the epidermal nevus appears as an acanthotic epidermal thickening, which is usually associated with hyperkeratosis.
Lymphocytic infiltration of the dermal layers of the skin can also be observed in patients with itching. The prognosis is excellent for patients with isolated epidermal nevus. There is usually no risk of degeneration.
Complications
An epidermal nevus is called a dermatological malformation. The mostly congenital anomaly originates in the pigment cells of the skin and has benign properties. Colloquially, the symptom is known as a birthmark or mole. The epidermal nevus is streaky to blotchy and beige in color.
At times the affected skin layer is speckled dark brown and slightly thickened. Depending on the severity, there is keratinization of the outer and inner organ surface of the skin at this point. The symptom can develop sub-forms over the years, some of which vary with other clinical pictures. In addition to the congenital birthmark, there are variants that occur due to immune disorders, environmental factors or hormonally.
As a rule, an epidermal nevus is free of complications. However, it can happen that some moles are very itchy and scarring. As a side effect to the symptom, those affected may have an incorrect growth of the nails. The actual complication is more of a cosmetic nature.
If the birthmark is in the visible area of the head, neck or cleavage, it is perceived as annoying, especially if it becomes ugly, keratinized, increased or significantly scarred. In that case, the skin lesion is removed. If the symptoms are too pronounced or if symptoms recur, the procedure may have to be repeated.
When should you go to the doctor?
A doctor should be consulted if there are changes in the general appearance of the skin. If the blemishes spread or if they increase in intensity, it is advisable to consult a doctor. If you experience itching or an uncomfortable feeling on your skin, we recommend that you see a doctor. If there are open wounds, they should be treated in a sterile manner. If this cannot be fully guaranteed, medical wound care should be sought. Germs can enter the organism through the open areas on the body, which can lead to further diseases.
In severe cases there is a risk of blood poisoning and thus a life-threatening condition. A doctor should be consulted in good time as soon as you feel unwell, fever, dizziness or a general feeling of illness. A doctor should be consulted if skin discoloration, swelling or inner restlessness occurs. If the changed complexion leads to emotional as well as mental impairments, a visit to the doctor is necessary. In the event of social withdrawal, decreased well-being, shame or a depressed mood, it is advisable to contact a doctor or therapist.
If there are behavioral problems, sleep disorders or reduced performance, a doctor is required. If the person concerned wishes to have the skin abnormalities removed, they should contact a surgeon and obtain comprehensive information about the cosmetic procedure and its options.
Treatment & Therapy
Since the epidermal nevus is often congenital and thus appears to be largely due to genetic factors, there is no causal therapy. Symptomatic treatment is possible, but not mandatory. Symptomatic treatment measures are used in the context of the skin anomaly, for example, if the patient perceives the birthmark as a cosmetic impairment.
In addition, symptomatic therapy can be useful in the case of more or less severe itching. Patients with itchy nevi are advised not to scratch their moles. Since itchy skin lesions can affect the patient’s quality of life to a greater or lesser extent, an excision is often suggested in this case.
Excision is an invasive treatment model. During the procedure, the birthmark is surgically removed by a dermatologist. Smaller nevi can be removed under local anesthesia within minutes. In the case of epidermal nevi in the facial area or larger nevi, a plastic surgeon usually performs the excision.
In this case, after the complete removal, the surgeon usually closes the defect aesthetically. The defect closure is mainly done in the face mostly through local shifting of the skin. If there are major changes in the epidermis, serial excision is performed.
The removal takes place in repeated interventions, with the surrounding skin being stretched piece by piece by means of a skin expander. The resulting defect is finally compensated for with the stretched skin.
Outlook & forecast
The prognosis of the epidermal nevus is favorable. It is a benign change in the complexion of the skin that normally does not show any mutations over its lifespan. Although the skin change is genetically determined and therefore there is no causal therapy, the epidermal nevus is in most cases without a medical disease value. Treatment is usually only required if the person concerned feels emotional suffering due to the visual abnormalities and sees a need for action.
In the event of complications such as itching or psychological impairment, the skin lesion is removed in a routine surgical procedure. The procedure is performed locally and is completed within a few minutes. As soon as the subsequent process of wound healing is complete, the patient can be discharged from the treatment as symptom-free.
In rare cases there are irregularities in the scar formation. These worsen the favorable prognosis as well as unexpected disturbances in the wound healing process. While a laser treatment can significantly improve scar formation, there is a risk of sepsis if the wound healing is irregular.
This has a potentially life-threatening course of the disease and must therefore receive medical attention and intensive care as quickly as possible. If medical treatment is delayed, the patient dies prematurely due to blood poisoning.
Prevention
The epidermal nevus cannot yet be completely prevented. Avoiding stimulating stimuli such as UV light and controlling the hormonal balance usually only helps to a limited extent if there is a genetic disposition.
Aftercare
In the case of this disease, follow-up measures are very limited or even not possible at all. As a rule, however, they are not necessary if the disease does not require treatment. First and foremost, a quick and, above all, early diagnosis is very important in order to treat the disease correctly and to classify the symptoms accordingly.
Independent healing cannot occur with this disease, so that the person concerned is always dependent on a medical examination. Since this disease can also lead to significant impairment of aesthetics, those affected are not infrequently dependent on psychological treatment. Intensive and loving conversations with your own parents or friends are also very useful, whereby contact with other affected persons can also be useful.
If the symptoms are removed by surgery, the wound should be protected after the operation so that an infection does not occur. Follow-up checks are also very important so that the healing process also proceeds without discomfort. As a rule, this disease does not reduce the life expectancy of the person affected and no further follow-up measures are necessary.
You can do that yourself
An epidermal nevus should definitely be clarified by a doctor and then treated if necessary. Symptomatic therapy is not absolutely necessary, but individual symptoms should be addressed to avoid serious complications.
Strict hygiene measures help if itching. The affected skin area is best protected from irritating influences such as care products or the cold. Special remedies from naturopathy alleviate the symptoms. For example, an ointment made from chamomile extract, which is applied directly to the skin lesion, has proven itself. If other skin changes occur, there may be a serious cause that must first be found and corrected. If the cause is a hormonal disorder, hormone therapy may have to be carried out.
Most of the time, however, it is enough to change your lifestyle and, for example, reduce stress. A healthy and balanced diet is also effective in treating hormonal imbalances, but also disorders of the immune system. If the symptoms are due to a vitamin D deficiency, the substance must be reabsorbed through the diet. If these measures show no effect, you should go to the doctor again with the epidermal nevus.
