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| CASE REPORT |
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| Year : 2013 | Volume
: 5
| Issue : 2 | Page : 88-90 |
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Isolated collagenoma on the scalp: A rare presentation
Surendra Kumar1, Satyendra Kumar Singh2, Alka Bansal3, Manish Bansal2
1 Department of Dermatology and Venereology, JLN Medical College, Ajmer, India
2 Department of Dermatology and Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
3 Department of Pathology, Swami Harshankaranand Ji Hospital and Research Center, Newada, Varanasi, Uttar Pradesh, India
| Date of Web Publication | 12-Dec-2013 |
Correspondence Address:
Manish Bansal
Department of Dermatology and Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-7753.122969
 Abstract | | |
Connective tissue nevi of the skin are benign hamartomatous lesions consisting predominantly of one of the components of the extracellular matrix comprising of collagen, elastin or glycosaminoglycans type. Connective tissue nevi may be solitary or multiple, sporadic or inherited. Collagenomas are asymptomatic and usually occurs over upper trunk, arms, back, thighs and soles. We, hereby report a young boy with collagenoma over the scalp, a rare site. Keywords: Collagenoma, connective tissue nevus, scalp
How to cite this article:
Kumar S, Singh SK, Bansal A, Bansal M. Isolated collagenoma on the scalp: A rare presentation. Int J Trichol 2013;5:88-90 |
| Introduction | |  |
Collagenomas or collagen nevi are a type of connective tissue nevi characterized by hamartomatous proliferation of collagen fibers in the dermis with normal, decreased or increased elastic fibers. They present as asymptomatic skin colored papules, plaques, nodules or swelling of variable size in grouped, solitary, linear/segmental or irregular distribution. We report a case of isolated giant collagenoma of scalp in an adult male patient.
| Case Report | | |
The present case is about a 20-year-old male patient who presented with an asymptomatic swelling on the left fronto-parieto-occipital region of the scalp since last 10 years. The swelling was insidious in onset, started as single papular lesion in the parietal region and gradually progressed to reach the present size [Figure 1]a. Contrast enhanced computed tomography scan of the head showed that the swelling was outside the skull bones, without any intracranial extension. Patient had gone to a plastic surgeon 5 years back and had undergone partial excision of the swelling. Excised tissue was subjected to histopathological examination at that time, but the report was not available with the patient. The swelling again increased in size and attained the present size. There was no history of trauma or any manual or other manipulation at the site prior to the development of the swelling. There was no history of spontaneous regression or reduction in size. There was no history of fainting and other localizing neurological sign. There was no feature suggestive of tuberous sclerosis such as adenoma sebeceum, seizures, ash leaf macules or confetti like macules. On physical examination, a well-defined circumscribed swelling measuring 14 cm × 11 cm, presented over scalp, involving left fronto-parieto-occipital region with some extension over right [Figure 1]a. It was firm in consistency and non-compressible with a smooth surface. The skin and hairs overlying the swelling were normal except the brownish discoloration of the skin. Linear scar of size 13.5 cm × 0.5 cm of previous surgery was present over the swelling on the left side [Figure 1]b. Systemic examination including skin, mucosa, nail and hair did not show any abnormality. A 4 mm incisional punch biopsy at the margin of swelling was sent for histopathological examination, which showed hyperplastic epidermis with thickened reticular dermis with dense collagen bundles that were arranged haphazardly in lower reticular dermis [Figure 2]a. A single terminal follicle showed dense perifollicular fibroplasia with an increased number of fibrocytes. Special staining with Masson's trichrome stain showed green colored collagen bundles arranged haphazardly [Figure 2]b. As patient had cosmetics concerns so he was referred to the plastic surgery for the complete excision of the lesion in steps.
| Discussion | | |
Connective tissue nevi are circumscribed hamartomatous malformations of the dermal extracellular matrix, i.e. of collagen, elastic fibers or glycosaminoglycans. [1] Connective tissue nevi may be solitary or multiple, sporadic or inherited. Collagen and elastic nevi are more common than glycosaminogycans type. Histopathological examination is the gold standard for the diagnosis. Collagen nevi are the hamartomatous malformations of the collagen and are classified into familial and non-familial types. [2] Familial include cutaneous collagenomas with autosomal dominant inheritance associated with cardiological abnormalities and shagreen patches associated with tuberous sclerosis. Non-familial include eruptive collagenoma and isolated collagenomas. Isolated collagenomas comprise of planter cerebriform collagenoma alone or associated with Proteus syndrome, linear or zosteriform collagenoma, knuckle pads collagenoma and papulolinear type of collagenoma. Collagenomas usually occurs over upper trunk, arms, back, thighs and soles. Scalp is a rare site of collagenomas with only few case reports. The study by Auada et al. reported two cases of scalp collagen nevi associated with Turner syndrome and considered it as resolving stage of lymphoedema. [3] In a study by Laxmisha et al. described isolated scalp collagenoma mimicking cutis verticis gyrata in a 35-year-old female with no associated abnormalities. [4] Isolated collagenoma of scalp can be differentiated from Buschke-Ollendorff syndrome More Details by absence of elastic nevi, lack of family history and normal X-rays of long bones and pelvis (no evidence of osteopoikilosis). Turner syndrome (XO genotype) is easily excluded as the case is a male patient with no associated suggestive clinical findings such as webbed neck, short stature, edema of hands, etc., The present case is a rare type of isolated collagenoma presenting over the scalp with no associated abnormalities.
| References | | |
| 1. | Uitto J, Santa Cruz DJ, Eisen AZ. Connective tissue nevi of the skin. Clinical, genetic, and histopathologic classification of hamartomas of the collagen, elastin, and proteoglycan type. J Am Acad Dermatol 1980;3:441-61. 
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| 2. | Atherton DJ, Moss C. Naevi and other developmental defects. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Textbook of Dermatology. 7 th ed. Oxford: Blackwell Publishing; 2004. p. 15.1-114.
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| 3. | Auada MP, Cintra ML, Puzzi MB, Viana D, Cavalcanti DP. Scalp lesions in Turner syndrome: A result of lymphoedema? Clin Dysmorphol 2004;13:165-8.
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| 4. | Laxmisha C, Thappa DM, Jayanthi S. Isolated scalp collagenoma mimicking cutis verticis gyrata. Indian J Dermatol Venereol Leprol 2006;72:309-11.
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[Figure 1], [Figure 2]
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