Diffuse neonatal hemangiomatosis: an evidence-based review of case reports in the literature.

BACKGROUND: The term "diffuse neonatal hemangiomatosis" has been used historically to describe multifocal vascular lesions affecting the skin and viscera in infants. OBJECTIVE: We hypothesized that many cases reported as diffuse neonatal hemangiomatosis did not have infantile hemangiomas (IH), but represented more recently described neonatal vascular diseases. METHODS: A literature search was performed using PubMed database (1950-2009) with the terms "neonatal hemangiomatosis," "benign hemangiomatosis," and "diffuse hemangiomatosis." A total of 180 articles were identified. Exclusion criteria included disease onset later than 3 years of age and absence of multifocal skin involvement. In all, 73 cases were selected and categorized into 3 groups: IH/probable IH; multifocal lymphangioendotheliomatosis with thrombocytopenia (MLT)/probable MLT; and multifocal vascular lesions, not otherwise specified. RESULTS: Of the 73 cases, 43 had IH/probable IH, 17 had MLT/probable MLT, and 13 had multifocal vascular lesions, not otherwise specified. The clinical outcomes of these groups differed in that two of 43 (5%) patients with IH died whereas 11 of 17 (65%) patients with MLT died (odds ratio 37.6, confidence interval 5.6-387.6, P value < .0001). LIMITATIONS: This was a literature-based meta-analysis, which inherently has limitations of incomplete and inconsistently presented information. CONCLUSIONS: Many cases reported in the literature as diffuse neonatal hemangiomatosis represent newly described multifocal vascular anomalies such as MLT, which has a strikingly higher mortality than IH. We propose the term "multifocal infantile hemangioma-with or without extracutaneous disease" instead of "diffuse neonatal hemangiomatosis" for multiple cutaneous IH. Accurate diagnosis of multifocal neonatal vascular lesions is imperative to facilitate appropriate evaluation, treatment, and prognosis.

Nevus simplex: a reconsideration of nomenclature, sites of involvement, and disease associations.

BACKGROUND: Nevus simplex (NS) is a common birthmark on the forehead, glabella, upper eyelids, and nape. More widespread involvement can be confused with port-wine stains (nevus flammeus) and other vascular birthmarks. OBJECTIVES: To further categorize the anatomic locations in infants with extensive NS and evaluate for any possible disease associations. METHODS: We conducted a retrospective review of patients with extensive NS seen at two tertiary care centers. RESULTS: Twenty-seven patients with extensive NS were identified. All had at least one typical site of involvement: glabella (77.8%), nape (59.3%), and eyelids (55.6%). Additional sites were the scalp, including the vertex, occiput, parietal (66.7%); nose (66.7%); lip (59.2%); lumbosacral skin (55.6%); and upper and mid back (14.8 %). LIMITATIONS: Retrospective nature of the study and relatively small sample size. CONCLUSIONS: We propose the term "nevus simplex complex" for NS with more widespread involvement beyond the typical sites. Consistent use of the term "nevus simplex" will aid in correct diagnosis and appropriate management of these birthmarks.

Allergic contact dermatitis from cigarettes.

Cigarettes are widely known to contain potent carcinogens, and their smoke contributes to many chronic and potentially fatal diseases. Cigarettes may also represent an underreported and underrecognized cause of allergic contact dermatitis (ACD). Potential allergens from cigarettes can be found in the filters, paper, and tobacco. This article reviews the current literature on ACD from cigarettes to understand the clinical manifestation of ACD from cigarettes, to recognize components in cigarettes as potential sources of ACD, and to describe how to patch-test patients with suspected ACD from cigarettes. The potential allergens discussed in this article include cocoa, menthol, licorice, colophony, and formaldehyde.