Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2022;12(2):e2022074 1 Follicular Becker Nevus: an Unusual Clinical and Dermoscopic Manifestation Li-wen Zhang1, Xue Shen1, Lei Xu1, Hai-peng Shi2, Tao Chen1 1 Department of Dermatovenereology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China 2 Department of Pathology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China Key words: Becker nevus, follicular, dermoscopy, papule Citation: Zhang L, Shen X, Xu L, Shi H, Chen T. Follicular Becker’s nevus: an unusual clinical and dermoscopic manifestation. Dermatol Pract Concept. 2022;12(2):e2022074. DOI: https://doi.org/10.5826/dpc.1202a74 Accepted: September 8, 2021; Published: April 2022 Copyright: ©2022 Zhang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Tao Chen, Department of Dermatovenereology, Chengdu Second People’s Hospital, 165 Caoshi Street, Chengdu 610017, Sichuan, China. E-mail: 13980427003@163.com Introduction Becker nevus (BN) is characterized by a unilateral, hairy, pigmented macule usually involving the chest or scapular re- gion. We hereby reported a specific case of follicular BN pre- senting follicular macules and maculopapules, and described its dermoscopic manifestation. Case Presentation A 20-year-old female presented with a 12-year history of multiple clustered asymptomatic brown macules and maculo- papules affecting the inside of the left upper arm (Figure 1A). The pigmented lesions gradually increased in the initial phase and then stabilized. No other accompanied systemic abnormality was found. Familiar and medical histories were unremarkable. The dermoscopy revealed multiple brown round perifollicular macules with thicker hairs in the folli- cles (Figure 1B). The histopathological examination showed hyperkeratosis, acanthosis, and darkly pigmented basal cell layer (Figure 1C). A diagnosis of follicular BN was made. Discussion BN, also called pigmented hairy epidermal nevus, is char- acterized by a unilateral, hairy, pigmented macule usually involving the upper chest or the scapular region, a few cases present multiple or bilateral. The pathogenesis is still unclear. The plausible explanations for BN include mosaicism and an androgen-dependent lesion [1]. BN has male predilection, with a 2:1 to 5:1 predominance of men over women [1]. BN commonly appears during adolescence and some cases are congenital. The lesions usually present as an asymptom- atic well-demarcated, irregular, brown macule with a geo- graphic or block-like configuration. However, Manchanda et al first reported an unusual clinical manifestation of BN in 2020, which presented follicular lesions [2]. They specu- lated that some BN might begin from perifollicular lesions and follicular epithelium might hold a significant role in the etiopathogenesis. The mechanism of follicular BN and the pathogenesis of BN remain to be further studied. BN usually do not require treatment, and some potential therapeutic options were taken due to cosmetic requirement, 2 Research Letter | Dermatol Pract Concept. 2022;12(2):e2022049 including electrolysis, waxing, makeup, laser treatment, and topical therapy. Currently, no consensus has yet been reached in the literature regarding which treatment is preferred and success with each treatment varies widely. Conclusions Follicular BN is an unusual clinical variant. The dermatolo- gist should be aware of the unusual clinical manifestation of BN, which could permit to quickly solve the clinical doubts and reassure the patient. References 1. Danarti R, Konig A, Salhi A, Bittar M, Happle R. Becker’s nevus syndrome revisited. J Am Acad Dermatol. 2004;51(6):965-969. DOI: 10.1016/j.jaad.2004.06.036. PMID: 15583590. 2. Manchanda Y, Khaitan BK, Ramam M, Das S, Al-Mutairi N. Follicular Becker’s Nevus: A New Clinical Variant. Indian J Dermatol. 2020;65(2):130-132. DOI: 10.4103/ijd.IJD_476_18. PMID: 32180599. PMCID: PMC7059461. Figure 1. (A) Multiple clustered brown follicular macules and maculopapules affecting the inside of the left upper arm. (B) The dermoscopy revealed multiple brown round perifollicular macules with thicker hairs in the follicles. (C) The histopathology showed hyperkeratosis, acanthosis, and darkly pigmented basal cell layer (H&E staining; ×200 magnification).