Case and Research Letters
Nevus Oligemicus on the Breasts: A Report of 2 Cases
Nevus oligemicus localizado en mamas: a propósito de 2 casos
E. Gutiérrez-Paredes
, V. López-Castillo, Á. Revert-Fernández, E. Jordá-Cuevas
Corresponding author
Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Spain
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Gutiérrez-Paredes, V. López-Castillo, Á. Revert-Fernández, E. Jordá-Cuevas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Gutiérrez-Paredes" "email" => array:1 [ 0 => "ev_gutierrez@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V." "apellidos" => "López-Castillo" ] 2 => array:2 [ "nombre" => "Á." "apellidos" => "Revert-Fernández" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá-Cuevas" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Nevus oligemicus</span> localizado en mamas: a propósito de 2 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 713 "Ancho" => 951 "Tamanyo" => 213687 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification x100. Vascular ectasia in the papillary dermis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Nevus oligemicus is a recently described dermatologic entity, first mentioned by Davies et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1981; few cases have been reported to date.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report 2 cases of women aged 66 and 81 years, identified as patient 1 and patient 2, respectively; the women were evaluated in our department in an interval of approximately 1 year due to the appearance of macules on both breasts. Physical examination revealed erythematous-violaceous telangiectatic macules on the breasts; the macules measured several centimeters and had irregular, poorly defined edges. Palpation caused the macules to turn white and revealed a local temperature that was markedly lower than that of the adjacent healthy tissue, with no signs of arterial ischemia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesions had appeared a year earlier and were asymptomatic. The patients stated that they had not experienced previous local trauma or an infection, or applied topical products. Patient 2 was hypertensive and had osteoporosis and early-stage Alzheimer disease, for which she had been receiving drug therapy for many years. The analyses carried out included a full blood count, biochemistry, coagulation assay, kidney and liver function tests, anticardiolipin antibody assay, antinuclear antibody and cryoglobulin assay, and serology for <span class="elsevierStyleItalic">Borrelia burgdorferi</span>, and all results were normal or negative. A skin biopsy was performed only in patient 2 and showed vascular ectasia in the papillary dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The lesions were diagnosed as nevus oligemicus and remained stable during a follow-up period of approximately 2 years; no new lesions appeared in this time.Nevus oligemicus is rarely reported in the literature; this may be because it is asymptomatic and sometimes not easily noticed, and is therefore underreported by patients or underdiagnosed. The etiology and pathogenesis are unknown, but an abnormality of the adrenergic receptors with increased sympathetic tone in the deep dermal vascular plexus has been suggested. This would lead to reduced deep vascular flow, which is responsible for regulating skin temperature, thereby causing the lesion to be cold to the touch, and relative vasodilation of the superficial vascular plexus, which feeds the tissue, thereby causing the erythema. The term <span class="elsevierStyleItalic">nevus oligemicus</span> may be translated as poorly vascularized nevus, and some authors consider it to be a functional rather than an anatomical disorder.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The disease manifests clinically as fixed, acquired erythematous-violaceous macules and sometimes in the form of whitish telangiectatic macules,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> with poorly defined, irregular edges. Palpation of the lesions causes them to turn white and, when measured using a thermometer, their temperature is at least 2<span class="elsevierStyleHsp" style=""></span>°C lower than that of adjacent healthy skin. The lesions are usually located on the abdomen and thighs,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4–6</span></a> and less frequently on the breasts<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> and hands.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> They are asymptomatic and only 1 case of abnormal local heat sensitivity has been reported.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although diagnosis is essentially clinical, histology, if performed, shows dilation of the vessels in the papillary dermis and occlusion of the vessels in the reticular dermis, with a normal number of vessels. Results of vasomotor tests are normal in both the uninvolved and involved skin<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3,5</span></a> and the finding supports the hypothesis that this is a functional anomaly. The only recognized trigger is prolonged bathing in cold water, which has led to the appearance of nevus oligemicus on the hands.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Contributing factors such as obesity, a sedentary lifestyle, and proximal pressure (such as that caused by a tight belt) have been suggested for lesions located on the abdomen, but weight loss and removing the pressure failed to resolve the lesions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Our patients were overweight, predominantly around the abdomen, and had large, sagging breasts.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The differential diagnosis should include inflammatory erythema (mastitis, cellulitis, erysipelas), which involves warm lesions that tend to resolve, capillary malformations with no changes in local temperature and with characteristic histologic signs, and livedo reticularis, which is characterized by an erythematous-violaceous reticular pattern.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6,8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In our patients, the lesions remained stable over time, with no changes in size or appearance, and no new lesions developed. Treatment with systemic corticosteroids was ineffective.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, we report 2 cases of nevus oligemicus on the breasts, which is a rare site; the only previously reported case on this site involved a single breast.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The key to diagnosis is the finding of permanent local hypothermia; it is therefore important to palpate the lesion to detect a reduction of between 2 and 2.5<span class="elsevierStyleHsp" style=""></span>°C in local temperature. We consider that the frequency of this entity is probably greater than indicated by a review of the literature, but that it may go unnoticed or unreported by patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Gutiérrez-Paredes E, et al. <span class="elsevierStyleItalic">Nevus oligemicus</span> localizado en mamas: a propósito de 2 casos. Actas Dermosifiliogr.2012;103:443-4.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 521 "Ancho" => 1401 "Tamanyo" => 100310 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient 2. Erythematous-violaceous telangiectatic macules, more evident on the right breast.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 713 "Ancho" => 951 "Tamanyo" => 213687 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification x100. Vascular ectasia in the papillary dermis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nevus oligemicus. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 18 | 34 |
| 2024 October | 102 | 44 | 146 |
| 2024 September | 108 | 32 | 140 |
| 2024 August | 149 | 54 | 203 |
| 2024 July | 91 | 42 | 133 |
| 2024 June | 114 | 43 | 157 |
| 2024 May | 103 | 42 | 145 |
| 2024 April | 89 | 18 | 107 |
| 2024 March | 94 | 41 | 135 |
| 2024 February | 112 | 36 | 148 |
| 2024 January | 99 | 30 | 129 |
| 2023 December | 83 | 21 | 104 |
| 2023 November | 105 | 28 | 133 |
| 2023 October | 81 | 24 | 105 |
| 2023 September | 104 | 36 | 140 |
| 2023 August | 70 | 22 | 92 |
| 2023 July | 85 | 30 | 115 |
| 2023 June | 71 | 26 | 97 |
| 2023 May | 89 | 44 | 133 |
| 2023 April | 72 | 34 | 106 |
| 2023 March | 63 | 27 | 90 |
| 2023 February | 70 | 23 | 93 |
| 2023 January | 40 | 30 | 70 |
| 2022 December | 65 | 45 | 110 |
| 2022 November | 44 | 44 | 88 |
| 2022 October | 28 | 24 | 52 |
| 2022 September | 34 | 53 | 87 |
| 2022 August | 28 | 40 | 68 |
| 2022 July | 17 | 32 | 49 |
| 2022 June | 29 | 24 | 53 |
| 2022 May | 55 | 35 | 90 |
| 2022 April | 78 | 47 | 125 |
| 2022 March | 57 | 56 | 113 |
| 2022 February | 92 | 27 | 119 |
| 2022 January | 135 | 40 | 175 |
| 2021 December | 67 | 38 | 105 |
| 2021 November | 66 | 54 | 120 |
| 2021 October | 55 | 52 | 107 |
| 2021 September | 58 | 46 | 104 |
| 2021 August | 61 | 31 | 92 |
| 2021 July | 47 | 30 | 77 |
| 2021 June | 35 | 23 | 58 |
| 2021 May | 41 | 45 | 86 |
| 2021 April | 117 | 87 | 204 |
| 2021 March | 75 | 26 | 101 |
| 2021 February | 48 | 29 | 77 |
| 2021 January | 47 | 23 | 70 |
| 2020 December | 46 | 11 | 57 |
| 2020 November | 27 | 13 | 40 |
| 2020 October | 38 | 8 | 46 |
| 2020 September | 44 | 11 | 55 |
| 2020 August | 30 | 26 | 56 |
| 2020 July | 33 | 18 | 51 |
| 2020 June | 43 | 31 | 74 |
| 2020 May | 29 | 11 | 40 |
| 2020 April | 41 | 12 | 53 |
| 2020 March | 29 | 22 | 51 |
| 2020 February | 5 | 6 | 11 |
| 2020 January | 4 | 13 | 17 |
| 2019 December | 8 | 5 | 13 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 8 | 6 | 14 |
| 2019 August | 4 | 6 | 10 |
| 2019 July | 4 | 13 | 17 |
| 2019 June | 6 | 11 | 17 |
| 2019 May | 6 | 15 | 21 |
| 2019 April | 2 | 22 | 24 |
| 2019 March | 18 | 4 | 22 |
| 2019 February | 2 | 5 | 7 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 1 | 0 | 1 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 3 | 0 | 3 |
| 2018 June | 0 | 4 | 4 |
| 2018 May | 0 | 2 | 2 |
| 2018 April | 0 | 2 | 2 |
| 2018 March | 0 | 3 | 3 |
| 2018 February | 86 | 5 | 91 |
| 2018 January | 160 | 10 | 170 |
| 2017 December | 119 | 9 | 128 |
| 2017 November | 110 | 8 | 118 |
| 2017 October | 144 | 6 | 150 |
| 2017 September | 178 | 7 | 185 |
| 2017 August | 193 | 10 | 203 |
| 2017 July | 220 | 7 | 227 |
| 2017 June | 213 | 10 | 223 |
| 2017 May | 209 | 8 | 217 |
| 2017 April | 141 | 9 | 150 |
| 2017 March | 70 | 25 | 95 |
| 2017 February | 60 | 9 | 69 |
| 2017 January | 64 | 9 | 73 |
| 2016 December | 80 | 5 | 85 |
| 2016 November | 90 | 13 | 103 |
| 2016 October | 149 | 12 | 161 |
| 2016 September | 239 | 8 | 247 |
| 2016 August | 165 | 5 | 170 |
| 2016 July | 73 | 11 | 84 |
| 2016 June | 14 | 16 | 30 |
| 2016 May | 11 | 11 | 22 |
| 2016 April | 9 | 4 | 13 |
| 2016 March | 21 | 7 | 28 |
| 2016 February | 12 | 5 | 17 |
| 2016 January | 8 | 1 | 9 |
| 2015 December | 10 | 1 | 11 |
| 2015 November | 32 | 3 | 35 |
| 2015 October | 29 | 5 | 34 |
| 2015 September | 15 | 3 | 18 |
| 2015 August | 13 | 5 | 18 |
| 2015 July | 90 | 7 | 97 |
| 2015 June | 118 | 7 | 125 |
| 2015 May | 117 | 10 | 127 |
| 2015 April | 107 | 9 | 116 |
| 2015 March | 107 | 6 | 113 |
| 2015 February | 87 | 4 | 91 |
| 2015 January | 77 | 11 | 88 |
| 2014 December | 109 | 11 | 120 |
| 2014 November | 78 | 11 | 89 |
| 2014 October | 97 | 15 | 112 |
| 2014 September | 62 | 8 | 70 |
| 2014 August | 84 | 12 | 96 |
| 2014 July | 109 | 15 | 124 |
| 2014 June | 110 | 15 | 125 |
| 2014 May | 60 | 8 | 68 |
| 2014 April | 48 | 1 | 49 |
| 2014 March | 56 | 6 | 62 |
| 2014 February | 84 | 6 | 90 |
| 2014 January | 66 | 4 | 70 |
| 2013 December | 53 | 5 | 58 |
| 2013 November | 37 | 6 | 43 |
| 2013 October | 28 | 6 | 34 |
| 2013 September | 24 | 4 | 28 |
| 2013 August | 35 | 10 | 45 |
| 2013 July | 28 | 13 | 41 |
| 2013 June | 15 | 8 | 23 |
| 2013 May | 15 | 7 | 22 |
| 2013 April | 12 | 8 | 20 |
| 2013 March | 15 | 8 | 23 |
| 2013 February | 45 | 5 | 50 |
| 2013 January | 28 | 3 | 31 |
| 2012 December | 21 | 3 | 24 |
| 2012 August | 2 | 1 | 3 |
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