Itchy Capillary Malformations: Unusual Appearance of Meyerson Phenomenon, a Case Series

Round 1

Reviewer 1 Report

Dear authors:

I read your manuscript with interest and think that this is a valuable case series that adds information to the “vascular anomalies commjnity”.

The paper is well written and structured. As a non-native English speaker I find only little spelling and grammar mistakes.

Could the authors add some words on where this finding could be useful in the common classifications, such as the ISSVA-classification?

Author Response

Thank you for your comments. The spelling and grammar mistakes have been revised. Moreover, a sentence regarding the impact of this phenomenon on the vascular anomalies classifications have been added. 

Reviewer 2 Report

The current manuscript presented a case series of 5 patients with the Meyerson phenomenon (MP), which has been reported in several skin conditions. Particularly, MP with vascular abnormalities has been rarely reported. But MP could be overdiagnosed because the exact mechanism regarding how it is associated with underlying diseases is not clear.  Thus, I would suggest the author clarify or discuss the following before it is accepted for publication:

• The “halo eczema” could be a coexisting condition with vascular malformation.
• In the case of nevus MP, surgical removal of the central nevus could lead to complete resolution of the halo dermatitis, indicating the target of the immune system was the underlying disease (nevus).
• The pathophysiology of MP is unclear. But the abnormal expression of intercellular cell adhesion molecule 1 (ICAM-1) and CD4 T cells have been implicated in disease pathogenesis. The authors should include these in Figure 2.
• Several small grammar issues could be fixed. For example "only few cases" (line 31) should be only "a few cases".   

Author Response

Thank you very much for your comments. The response to the commentaries can be seen below: 

• The possibility of over-diagnosis and the casual association of a vascular malformation with a eczema without a pathogenic link has been added to the discussion.
• The indicated facts about ICAM-4 and T cells have been added to the figure. 
• Grammar issues have been revised.

Reviewer 3 Report

The authors report a case series of 5 patients with capillary malformation that developed eczematous changes. This is a quite common observation that is not well known for pediatricians.  My comments are: 

1) I would consider changing  the wording of the first sentence in the discussion: Meyerson phenomenon or “halo-eczema” developing over vascular anomalies is rarely observed in pediatric and dermatologic consultations, and consider saying that is a phenomenon rarely recognized. 

2) It can be useful to include a sentence explaining that when this phenomenon occurs after laser may be erroneusly considered by parents as a poor response to laser treatment. 

 

Author Response

Thank you very much for your comments. The changes are listed below:

• The wording of the first sentence of the discussion have been improved.
• The possible wrong consideration of a lack or response of the vascular malformation to laser treatment when Meyerson Phenomenon appears have been included.