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Generalized Vesicles and Erythematous Papules with Bullae on Bilateral Ankles in a 6-year-old Boy
Hsin Huang , Tzei-Yi Lin, Chau-Hong Liu, Shu-Rung Shei
Dermatol Sinica 23:48-49,2005

CASE REPORT
A 14-year-old boy with nonspecific family history presented with several pink to red papules on his right nose and cheek for 2 years. The facial lesions appeared initially on the nasal ala as small, flesh-to-pink-colored, and mildly protruding pimples. He was brought to several dermatological clinics with the impression of acne vulgaris in the past 2 years. Some papules got improved months later, but some got worse with an intensified color when exercising. These "non-resolving acne" were strictly confined to the right side of the face. (figure 1) A close dermatological finding of these papules showed a smooth and glistening surface, and a diameter ranging from 0.1 to 0.3 cm were noted. (figure 2)
Histologically, it showed pachy irregular dilation of vascular channels in the upper dermis, significant perivascular and periadnexal fibrosis, and scattered large stellate fibroblasts in the dermal stroma. (figure 3) Thus the diagnosis of segmental tuberous sclerosis with unilateral facial angiofibromas was made. Carbon dioxide laser was performed but showed only partial response, and new lesions persisted to grow on the right side of the face. Brain MRI showed nonspecific findings. The chest X ray and renal sonography showed normal findings.
Throughout the course there were no other dermatological findings in the boy. Both of the boy’s parents were normal in health, and this boy was the only child of his parents.

   
   
 
 
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