Tympanoxyloid verruciform xanthoma is a distinct feature of CHILD nevus

The CHILD nevus represents a hallmark of CHILD syndrome [congenital hemidysplasia with ichthyosiform nevus and limb defects, MIM: 308050]. This X-linked dominant, male-lethal disorder is caused by NSDHL mutations blocking the cholesterol pathway.1 The CHILD nevus can be distinguished from other epidermal nevi by the presence of ptychotropism, waxy yellow scaling, and a conspicuous lateralization pattern showing either diffuse involvement or linear lesions or both.2 Most of the light microscopical features are indistinguishable from those of psoriasis, including exocytosis of neutrophils that form superficial accumulations reminiscent of Munro abscesses.