J Am Acad Dermatol 2013 Nov 21;69(5):768-775. Epub 2013 Aug 21.
Center of Competence for Neurofibromatosis, CHU Montpellier, Montpellier, France; University of Montpellier 1, Department of Dermatology, Saint-Eloi Hospital, CHU de Montpellier, Montpellier, France; Center of Competence for Pediatric Genetic Skin Disorders, CHU Montpellier, Montpellier, France. Electronic address:
Background: Children with multiple café-au-lait macules (CALMs) may be followed for years before a second National Institutes of Health clinical criterion of neurofibromatosis type 1 (NF1) develops to confirm the diagnosis.
Objective: We sought to assess the prevalence of nevus anemicus (NA) in NF1 and its association with neuro-ophthalmologic complications.
Methods: This was a prospective multicenter case-control study of 210 consecutive patients with multiple CALMs. Patients with NF1 were matched for age, sex, and center with control subjects. We documented the number, location, and morphologic appearance of NA; dermatologic features of NF1; magnetic resonance imaging results; and family history.
Results: In all, 77 (51%) patients with NF1 had NA compared with 6 (2%) control subjects. NA was not detected in 26 patients with other genodermatoses associated with CALMs. Patients with NF1 and NA were younger than those without NA (median age: 17 years) (P = .002). NA was mostly localized to the upper anterior aspect of the chest. NA was not significantly linked with other clinical manifestations of NF1, including optic glioma and unidentified bright objects.
Limitations: A potential referral bias associated with tertiary care centers is a limitation.
Conclusions: NA appears to have a high prevalence and specificity in NF1 and might serve as a marker for NF1 in children with multiple CALMs.