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Author: Dr Leah Jones, Dermatology Registrar, Waikato Hospital, New Zealand. Copy edited by Gus Mitchell. February 2022
Phakomatosis pigmentovascularis (PPV) is a rare congenital syndrome, predominantly consisting of a vascular malformation and dermal melanosis.
PPV is a mosaic abnormality of vasomotor nerves and melanocytes resulting in its characteristic cutaneous manifestations. A small proportion of patients have associated systemic features.
PPV is a mosaic developmental abnormality of the vasomotor nerves and melanocytes (derived from the neural crest).
It is caused by sporadic mutations in GNA11 and GNAQ genes, which encode Gα subunits of heterotrimeric G proteins. These genetic mutations have been detected in affected tissues, but undetectable in the blood, suggesting it is a post-zygotic mosaic disorder.
There are a number of other cutaneous associations depending on the subtype, such as:
There are five types of phakomatosis pigmentovascularis. These are distinguished based on cutaneous signs. Each type is further divided into subtypes A and B, depending on whether there is systemic involvement (as evident in subtype B). Type ll is the most common (port-wine stain with dermal melanosis).
|I||Capillary malformation, epidermal naevus|
|II (Cesioflammea)||Capillary malformation, dermal melanosis (lumbosacral dermal melanocytosis, nevus of Ota)|
|III (Spilorosea)||Capillary malformation, naevus spilus, naevus anaemicus|
|IV (Unclassified)||Capillary malformation, dermal melanosis (lumbosacral dermal melanocytosis, naeus of Ota), naevus spilus, naevus anaemicus|
|V (Cesiomarmorata)||Cutis marmorata telangiectatica congenita, dermal melanosis (lumbosacral dermal melanocytosis, naevus of Ota)|
Phakomatosis pigmentovascularis has been associated with a variety of systemic abnormalities. These are only present in a small proportion of patients.
Systemic features can include:
Phakomatosis pigmentovascularis is most common in the darker skin types seen in Asian ethnicities. The dermal melanosis presents as a blue/grey pigmentation and can be mistaken for bruising. The erythema associated with vascular malformations can be less prominent in darker skin types.
The complications associated with phakomatosis pigmentovascularis depend on any associated systemic involvement.
Complications can include:
Phakomatosis pigmentovascularis is a clinical diagnosis based on the combination of the associated cutaneous findings.
Specific genetic analysis of affected tissues can be performed.
No treatment is required for the capillary malformation or dermal melanosis. If treatment is desired for cosmetic reasons, laser treatment can be used, such as:
The recurrence risk of phakomatosis pigmentovascularis in subsequent pregnancies is close to zero given it is associated with a mosaic issue and normal egg and sperm. This is true for both the parents of the affected child and the affected child’s future offspring.
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