Blue Rubber Bleb Nevus Syndrome

BRBNS is a pretty rare syndrome and may show up in your office for purely cosmetic reasons, in that the patients may not like the dark papules that appear on their skin, but in fact it is one of those dermatoses that may, in rare instances, kill the patient.  It is an external manifestation of an internal disease.

As I said in the overly leading subject heading for the pic, they are soft, compressible papules that may be tender but usually are not, are often described as "nipple-like" in consistency and may bleed on occasion.  They can also have hyperhidrosis in the surrounding skin.They are actually growths of venules, and are most commonly a sporadic presentation, although they can also be inherited in autosomal dominant fashion.  

The big deal with BRBNS is that it is associated with gut and GU tract bleeding, which can rarely lead to fatal hemorrhage.  Also the respiratory system may be affected, and they can have intracranial lesions that may hemorrhage, leading to neural impairment and blindness.  

I know most of you are not familiar with this syndrome, but I also know that many of you see some crazy stuff out there, and so now you have another arrow in your quiver.

Today's bonus:  name three very well known big bands from the late 1930's and 1940'S.  Three points. Why, you ask?  Because one of the best ways to connect with our patients is through common cultural bonds, and a lot of those older people feel alienated from today's culture.  Next time, try to ask them (if they're in their 80's) who their favorite big band was.  Might trigger a cool conversation! And might get you a fan that will refuse to see anyone but you.  It's good to have your own fan club. It's job security.