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. 2021 Nov;85(5):1253-1258.
doi: 10.1016/j.jaad.2020.08.047. Epub 2020 Aug 18.

Cutaneous findings in Fanconi anemia

Jenna L Ruggiero  1 , Melissa Dodds  2 , Rebecca Freese  3 , Ingrid C Polcari  2 , Sheilagh Maguiness  2 , Kristen P Hook  2 , Christina Boull  2
Affiliations

Cutaneous findings in Fanconi anemia

Jenna L Ruggiero et al. J Am Acad Dermatol. 2021 Nov.

Abstract

Background: Fanconi anemia (FA) is a genetic disorder that results in bone marrow failure, physical abnormalities, and solid organ malignancies. The diagnosis of FA is often delayed because the early disease characteristics have not been well established.

Objective: To outline the spectrum of cutaneous findings seen in patients with FA.

Methods: A cross-sectional study in which patients with FA received a full-body skin examination. Patient characteristics are summarized with mean (SD) for continuous and count (%) for categorical variables. Poisson regression and logistic regression models were used to examine the relationships between pigmentary changes and patient characteristics.

Results: At least 1 cutaneous pigmentary alteration was present in 96.8% of patients, most arising before the teenage years. The most common finding was café-au-lait macules. Other findings included hypopigmented macules, skin-fold freckle-like macules, extensive sun-exposed freckling, and both hypopigmented and hyperpigmented pigment macules.

Limitations: Patients received a single assessment, so the number of pigmentary changes could not be assessed over time.

Conclusions: Characteristic morphology of FA includes faint and ill-defined café-au-lait macules, hypopigmented skin-fold freckle-like macules and the concurrence of hypopigmented and hyperpigmented macules. The recognition of these findings could aid clinicians in making earlier diagnoses.

Keywords: Fanconi anemia; café-au-lait macules; diagnosis; graft-versus-host disease; hematopoietic stem cell transplantation; hyperpigmentation; hyperpigmented macules; hypopigmentation; hypopigmented macules; radiation; skin-fold freckle-like macules; skin-fold freckling; sun-exposed freckling; voriconazole.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1.
Figure 1.
Fanconi anemia: Faint, ill-defined café-au-lait macules or “shadow spots”.
Figure 2.
Figure 2.
Fanconi anemia: Flexural hyperpigmentation with superimposed hypopigmented freckle-like macules within the skin fold (axilla).
Figure 3.
Figure 3.
Fanconi anemia: Concurrent diffuse hyper- and hypopigmented macules. Black arrows show hypopigmented freckle-like macules.
See this image and copyright information in PMC

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