A case report of Locus minors resistentiae,

an association of verruca with nevus

sebaceous.

BY : DR VARSHA K L
 INTRODUCTION
• Locus minoris resistentiae (LMR) is a site that offers
lesser resistance or increased vulnerability than the rest
of the body to the onset of disease.
• Trauma, irradiation, healed herpes scars, or chronic
lymph stasis commonly act as LMR, leading to
localization of numerous inflammatory, infectious and
neoplastic conditions.
• Areas of cutaneous mosaicism act as congenital LMR.
• The occurrence of an infectious condition such as
verrucae over areas of cutaneous mosaicism is rare.
 CASE REPORT
• A 14-year-old female child, presented with an
asymptomatic single orange-brown raised lesion over
the scalp since 3years.

• On examination a solitary well-defined verrucous

orange-brown plaque with filiform growth present
over the scalp.

• Dermoscopy revealed mutiple white keratotic cysts

over orange red background and finger like projection
were noted at one end.
 INVESTIGATIONS
• Routine blood investigations were normal.

• Biopsy from orange-brown plaque revealed

orthokeratosis, acanthosis, and defective hair follicle with
conglomeration of the sebaceous gland, suggestive of
nevus sebaceous.

• Biopsy of the filiform lesion revealed hyperkeratosis,

parakeratosis, acanthosis, marked papillomatosis and
koilocytic changes, suggestive of filiform wart.
• On the basis of clinico-histopathological findings, a diagnosis of filiform wart
over nevus sebaceous was confirmed.
TREATMENT GIVEN
• Patient was counselled regarding benign nature of the condition and it’s
prognosis.
• Verruca vulgaris lesion was radiocauterized.

DISCUSSION
• LMR can also be considered as isotopic or isoloci response, can be congenital
or acquired.
• This term denotes a regional immune dysregulation caused by failure of lymph
flow or altered neuropeptide release.
• Areas of cutaneous mosaicism such as epidermal nevi, lichen striatus,
congenital hemangioma, act as congenital LMR.
• Whatever the cause, an immunocompromised district may become a vulnerable
site, prone to developing opportunistic infections, tumors, or dysimmune
reactions strictly confined to the district itself; the opposite may also occur with
systemic immune disorders or malignancies that selectively spare the district.
• Nevus sebaceous of Jadassohn is a benign hamartoma with epidermal, follicular,
and apocrine elements, which is postulated to develop due to genetic
mosaicism in stem cells that expand in the lines of Blaschko.
• The occurrence of an infectious lesion over an area of cutaneous mosaicism is a
rare example of LMR.
• Carlson et al. detected HPV DNA in 82% of nevus sebaceous.
• Whether HPV represents a commensal infection caused by localized cutaneous
predisposition or is an essential factor in pathogenesis of nevus sebaceous is
unknown.
 CONCLUSION
This is reported to emphasize that any growth over nevus sebaceous
should raise the suspicion of associated verruca and neoplasms and
should be confirmed histopathologically.
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Thank you ...