Acquired bands of infancy

ARTICLE

Auteur(s) : Marjolein AC Mattheij¹, Louis AA Kollee², Cecile JM Buzing³, Marieke MB Seyger⁴

¹Department of Paediatrics, Jeroen Bosch Hospital, PO box 90153, 5200 ME ’s-Hertogenbosch, The Netherlands
²Department of Paediatrics, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, The Netherlands
³Department of Paediatrics, Canisius Wilhelmina Hospital, PO box 9015, 6500 GS Nijmegen, The Netherlands
⁴Department of Dermatology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, The Netherlands

Congenital ring constrictions coexisting with amputations or other abnormalities are rare malformations occurring in 1:10:000-1:45:000 births. The amniotic band hypothesis suggests that, following an amniotic tear, fibrous bands produce constrictions which may progress to amputation [1]. We describe a patient with a congenital constriction band in combination with acquired raised bands becoming apparent after birth. Information from the scarce literature is reviewed.

Case report

Her medical history included premature rupture of membranes and caesarean section at 28 weeks gestation because of foetal distress. Antenatal sonography showed oligohydramnion at a gestational age of 27+5, but no abnormalities at a gestational age of 25+0 and 26+0 weeks. No record was made of any amniotic bands. The girl underwent surgery because of a persistent ductus arteriosus and received diuretics because of mild bronchopulmonary dysplasia. The skin lesions were diagnosed as acquired raised bands of infancy. At the age of 1.6 years the lesions were unchanged.

Raised bands of infancy seem even rarer than congenital constriction bands, with only 5 case reports to date [1-5]. In 2002, two premature infants with so called postnatally developing “raised limb bands” were described [1]. One child had a congenital constriction band around the forearm and premature termination of the right hallux and second toe. Because of the unfamiliarity of the lesions, both children underwent chromosome analyses, biochemical, hematological, immunological investigations and skeletal surveys, which showed no abnormalities. Biopsies of the raised bands showed mild edema of the dermis in one child and a poorly circumscribed area in the dermis, composed of collagen with mild perivascular chronic inflammation in the other child; very unspecific findings. The fourth described patient, with both truncal and extremity lesions [3], made the authors propose the term “acquired raised bands of infancy”. The lesions in our case show various stages: from hypopigmented atrophic to skin-colored raised bands. How these different stages develop, which can also exist at the same time [1, 3], remains unknown. The development of the skin, as well as the period of time that the constriction occurred, might play a role.

In table 1 the most important features of all the patients known with acquired raised bands are shown. Half of the patients were born preterm. Suggestions that amniotic bands play a role in the development of raised bands seem plausible because of the associated limb constrictions seen in two patients – including our patient –, the congenital constriction bands in three patients, and the presence of amniotic bands at antenatal sonography in one patient. A shortcoming is the scarcity of sonographic results mentioned; detecting amniotic bands in utero would make the hypothesis of amniotic bands as the cause of the skin deficits even more plausible.

From the literature published to date, a few conclusions can carefully be drawn and can be used for parent information. i) Association with amniotic bands seems likely. ii) The raised bands are asymptomatic and without any significant sequelae. iii) Additional laboratory, radiological investigations or skin biopsy are unnecessarily damaging. iv) New acquired bands can develop until at least the age of 1 year. v) There is a chance of partial remission, but is seems more probable that the skin lesions will remain more or less visible. vi) There are no treatment options. Surgical intervention should be avoided.
Table 1 Information of all patients reported with acquired raised bands

Acknowledgements

References

2 Russi DC, Irvine AD, Paller AS. Raised limb bands developing in infancy. Brit J Derm 2003; 149: 436-7.

3 Dyer JA, Chamlin S. Acquired raised bands of infancy: association with amniotic bands. Ped Derm 2005; 22: 346-9.

4 Lateo SA, Taylor AEM, Meggitt SJ. Raised limb bands developing in infancy. Brit J Derm 2006; 154: 791-2.

5 Marque MM, Guillot B, Le Gallic G, Bessis D. Raised bands in infancy: a post-traumatic aetiology? Br J Derm 2007; 156: 578-9.