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Arch Pediatr Adolesc Med. 2007;161(5):472.

Denouement and Discussion: Meyerson Phenomenon Within a Congenital Melanocytic Nevus
The Meyerson phenomenon refers to a localized eczematous eruption that has been most commonly described in association with acquired melanocytic nevi (Figure 2); such a lesion may be referred to as a Meyerson nevus.^1-2 The terms halo dermatitis and halo eczema are also frequently used to describe such nevi.^2-3 A halo nevus, however, is a different entity and refers clinically to a nevus that is surrounded by a rim of hypopigmentation. Halo nevi may eventuate in complete disappearance of the associated pigmented lesion, whereas this is not seen with Meyerson nevi.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Figure 2. Erythematous scaly plaque with minimal crust surrounding an acquired melanocytic nevus.

The Meyerson phenomenon within nevi is not frequently described in dermatology textbooks, though the incidence is likely not rare. Such lesions are most frequently described in otherwise healthy young adult men and demonstrate a predilection for the trunk and proximal extremities.⁴ Published accounts of Meyerson nevi in infancy, such as the case presented here, are much less frequent. The pathogenesis of the eczematous reaction is not known, but immunological mechanisms may be crucial, as discussed by Brandt et al⁵ in describing a patient who developed halo nevi and vitiligo following excision of a Meyerson nevus. Although generally limited to a single melanocytic lesion, involvement of numerous nevi in a single patient has been described.⁶ Pruritus is not uncommon, but involved nevi are not likely to be otherwise bothersome to patients. The Meyerson phenomenon is typically described in association with benign acquired nevi, though a small case series of patients who had involvement of atypical nevi has been reported.⁷

Similar eczematous reactions have also been described in nonmelanocytic lesions, such as seborrheic keratoses, basal cell carcinomas, squamous cell carcinomas, dermatofibromas, keloids, and congenital capillary malformations (eg, port-wine stains).^4-5,8-9 When this phenomenon is observed in overlying nuchal-occipital capillary malformations, the dermatitis may be quite difficult to treat, and in such cases, treatment of the malformation with a pulsed dye laser may expedite resolution of the dermatitis.⁹

The Meyerson phenomenon is generally regarded as self-limited, and as such, the dermatitis should clear within a few months and may not require treatment. However, local treatment of the involved skin with topical midpotency corticosteroids may provide acceptable relief of associated pruritus with possible total clearance of the dermatitis. Despite resolution of the dermatitis, the pigmented lesion will persist.¹⁰ If the eczematous reaction recurs or persists despite treatment, excision of the nevus could be undertaken with expected subsequent clearance of the dermatitis.¹¹ Excision may be limited to the pigmented lesion and need not include the halo of dermatitis.¹²

Histologic evaluation of excised Meyerson nevi will demonstrate nests of nevus cells distributed in a pattern typical of the clinical appearance (eg, compound nevus or with features consistent with a congenital melanocytic nevus). There is no microscopic evidence of regression of the pigmented lesion. Histologic features of parakeratosis, acanthosis, and spongiotic changes noted in association with a superficial chronic lymphocytic infiltrate are consistent with the clinical picture of a superimposed dermatitis.⁴

AUTHOR INFORMATION
Correspondence: Joanna M. Burch, MD, Department of Dermatology, University of Colorado, PO Box 6510, Mail Stop F703, Aurora, CO 80045 (joanna.burch{at}uchsc.edu).

Accepted for Publication: August 1, 2006.

Author Contributions: Study concept and design: Tauscher and Burch. Acquisition of data: Tauscher and Burch. Analysis and interpretation of data: Tauscher and Burch. Drafting of the manuscript: Tauscher. Critical revision of the manuscript for important intellectual content: Tauscher and Burch. Study supervision: Burch.

Financial Disclosure: None reported.

REFERENCES
1. Meyerson LB. A peculiar papulosquamous eruption involving pigmented nevi. Arch Dermatol. 1971;103:510-512. FREE FULL TEXT 2. Nicholls DS, Mason G. Halo dermatitis around a melanocytic naevus: Meyerson's naevus. Br J Dermatol. 1988;118:125-129. FULL TEXT | WEB OF SCIENCE | PUBMED 3. Fernandez Herrera JM, Aragues Montanes M, Fraga Fernandez J, Diez G. Halo eczema in melanocytic nevi. Acta Derm Venereol. 1988;68:161-163. WEB OF SCIENCE | PUBMED 4. McKee P, Calonje E, Granter S. Pathology of the Skin: With Clinical Correlations. Vol 2. 3rd ed. Philadelphia, Pa: Elsevier Mosby; 2005.5. Brandt O, Christophers E, Folster-Holst R. Halodermatitis followed by the development of vitiligo associated with Sutton's nevi. J Am Acad Dermatol. 2005;52(suppl 1):S101-S104. FULL TEXT | WEB OF SCIENCE | PUBMED 6. Vega J, Angel Rodriquez M, Martinez M. Eczematous halo reaction in congenital pigmented nevus. Int J Dermatol. 2003;42:895. FULL TEXT | WEB OF SCIENCE | PUBMED 7. Petit A, Viney C, Gaulier A, Sigal M. Coexistence of Meyerson's with Sutton's naevus after sunburn. Dermatology. 1994;189:269-270. WEB OF SCIENCE | PUBMED 8. Elenitsas R, Halpern A. Eczematous halo reaction in atypical nevi. J Am Acad Dermatol. 1996;34:357-361. WEB OF SCIENCE | PUBMED 9. Tay YK, Morelli J, Weston W. Inflammatory nuchal-occipital port-wine stains. J Am Acad Dermatol. 1996;35:811-813. FULL TEXT | WEB OF SCIENCE | PUBMED 10. Hofer T. Meyerson phenomenon within a nevus flammeus: the different eczematous reactions within port-wine stains. Dermatology. 2002;205:180-183. FULL TEXT | WEB OF SCIENCE | PUBMED 11. Brenan J, Kossard S, Krivanek J. Halo eczema around melanocytic nevi. Int J Dermatol. 1985;24:226-229. WEB OF SCIENCE | PUBMED 12. Cox NH, Bloxham C, Lawrence C. Halo eczema: resolution after excision of the central nevus alone. Clin Exp Dermatol. 1991;16:66-67. FULL TEXT | WEB OF SCIENCE | PUBMED

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Arch Pediatr Adolesc Med. 2007;161(5):471.
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