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What causes a patch of discolored rough skin on the back?

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Practicing since : 2010
Answered : 6247 Questions
Hello Dr. Kumar! You were wonderful in allaying some health anxiety over some skin issues several months ago, so I thought I'd consult with you on another neurotic question pertaining to my son. Unfortunately, a combination of my health anxiety and BIG mistake of consulting "Dr. Google" has my mind imagining the worst with regard to my son. My son XXXXXXX is 19 years old and has no diagnosed medical issues. I noticed back when he was about eight or ten years old that he had a mark resembling a cafe any lait mark on his back, in the upper shoulder area. I had always asked the pediatrician to look at it during his yearly physicals, and they made nothing of it. Throughout the years it has grown a bit, and has became darker and more rough in texture. It is probably slightly less than an inch in length and looks like a few small lesions grouped together. Again, I've brought it to the pediatrician's attention and he was not concerned. This past July I made an appointment for him and my other son with a dermatologist for a skin exam, and I pointed out the spots which I wanted checked in particular. We met with the physicians assistant there, and my younger son had a peculiar spot I pointed out, of which the PA conducted a shave biopsy, which came back as a mildly atypical junctional nevus. For my older son XXXXXXX I pointed out the spot on his back/shoulder, and the PA diagnosed it as a linear epidermal nevus. She said the chances of it becoming dangerous are slim to none, it may darken throughout the years, and they will simply monitor it at yearly visits. Unfortunately, neurotic mom, yours truly, went on to google epidermal nevus and of course I ran into information showing a possible link to epidermal nevus syndrome and all of its associated neurological and skeletal defects. As I said, XXXXXXX is 19 and has no medical issues, is extremely intelligent, etc. His right shoulder tends to look lower than the left (neurotic mom here thinks skeletal issues!) but mine is actually like that as well, and I think it's due to his carrying heavy backpacks on that shoulder. In your opinion, is it safe to say that I should not be concerned about those syndromes...I presume it's primarily related to numerous and systemic epidermal nevi, which he does not have, and I would think it would have presented by now? And my last even more neurotic question (I will no longer google medical conditions anymore!!!) ... of course my neurotic online research led me to some information saying that a certain type of epidermal nevus (epidermolytic??) could be related to a gene mutation that could be passed along to offspring, with them having possible serious skin scaling conditions, etc. Again, he has just one solitary small epidermal nevus. No biopsy was done, as the PA did not feel it was necessary. Do you feel there is any need for me to worry about that potential genetic mutation? Thank you so much for reading my long and neurotic question.....just when you thought you'd probably seen and heard it all, along comes a google-induced neurotic question (any other parent probably would have just taken a note of what the Derm said for what it was, and just been reassured at that point!).
Posted Tue, 28 Nov 2017 in null
Answered by Dr. Rahul Kumar 20 hours later
Brief Answer:
Photograph required

Detailed Answer:
Thanks for the query and detailed history.
I can understand your concern.
Can you please upload a photograph of the involved area.
This will help me in giving a closer diagnosis and better way of management and I would be in a better position to answer all your queries.
Waiting for your response.
Above answer was peer-reviewed by
Follow-up: What causes a patch of discolored rough skin on the back? 2 hours later
Hi Dr. Kumar! Thank you for your response! Unfortunately, I'm not attaching a photograph, as I do not want to ask my son to let me take one....I don't want him to think that I'm doubting the dermatologist's diagnosis or worried about the same!

I apologize for not being able to assist you with a photo, but would you be able to answer my question based upon the Derm's diagnosis of a small and solitary epidermal nevus?

Again, it first appeared when he was about 10 or 12 years old as a lightly pigmented spot, resembling a cafe au lait spot. He is 19 and throughout the years it has darkened and grown just a small bit and has become a bit rougher. It is about three quarters of an inch and is located on the back of his left shoulder. The Derm examined it with a dermascope and diagnosed it as a linear epidermal nevus...he has no other ones.

I had also called the derms office for further information and she told me they are common and they see them frequently, his is just a small spot and is of no concern. I called his pediatrician to ask about those rare syndromes and gene mutations and she reiterated that what he has is somewhat commonplace and insignificant. I guess I'm just looking for some further reassurance for my anxiety!!
Answered by Dr. Rahul Kumar 11 hours later
Brief Answer:
Nothing to worry

Detailed Answer:
Thanks for the follow up.
Small epidermal nevs is totally harmless.
Neither it is related with any syndrome not with any pre cancerous changes.
It is just of cosmetic importance.
Just relax there is nothing to worry.
He is absolutely fine.
Let me know if you have any other doubts.
Above answer was peer-reviewed by
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