Question: Hello Dr. Kanodia! 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!).

Hi Dr. Kanodia...thank so much for your reply! Unfortunately, I think my son wouldn't be too happy if I asked him to let me take a picture of the spot, and I really don't want to alarm him with thinking I'm worried about it, after we've already visited the Derm.

Again, it looks a lot like some of hr images I've googled. I first noticed it when he was about ten years of age, it started as a light brown patch resembling cafe au lait spot, and his pediatrician was never concerned about it. Throughout the years it's darkened and thickened a bit as he's gone through adolescence. It has not grown or changed in the last several years. It is anout 3/4 of an inch and looks like three small papules grouped together. The Derm did examine it with an dermascope and diagnosed it as a linear epidermal nevus with no hesitation.

Sorry that I can't fulfill your request of an image. If we assume it's just a small, solitary epidermal nevus of that size (he has no others), would you be able to answer my questions based upon that? Thank you!!"

Oh Dr. Kanodia....I cannot thank you enough for your kind, compassionate, and reassuring response! You are truly a very, very special physician, and the work you do in this forum is such an incredible service to people with both "run of the mill" and "neurotic" questions such as mine! Since you're a father, you clearly understand how sometimes overly obsessive we can become with worrying about our children!

My major trigger has been googling these conditions, which invariably leads to references to obscure and rare conditions, and when you're suffering from health anxiery it becomes next to impossible to separate them from reality (I'm currently going through peri-menopause and I am convinced my hormonal changes are exacerbating my otherwise controllable anxiety!)

No more medical googling for me! But I thank you immensely for talking me out of my unrealistic panic on this one!

One last question... XXXXXXX has been diagnosed with keratosis pilaris (his father has it as well), and oftentimes in the cold winter months here in the northern US the palms of both of his hands get dry and the skin peels; moisturizing lotions seem to help. Of course, in my neurotic googling of epidermal nevi I was somehow brought to a reference of palmar something or other, related to that keratin gene mutation (just when you thought you heard it all lol!). Can I just presume more realistically that this is just some simple
exzema and nothing worrisome?

Thank you again so very much for you kindness and compassion Dr. Kanodia!!!