Thursday, July 20, 2006

Hypopigmentation in atopic dermatitis

This is a 7-year-old boy who developed multiple patches of hypopigmentation on the dorsum of the hands for 3 years. He had a history of atopic dermatitis and had severe eczema of the hands prior to development of the hypopigmentation on the hands. According to the mother, he had secondary infection with crusts formation on the hands. The lesions were patchy hypopigmented macules mainly on the dorsum of the hands and feet. There were no family history of similar pigmentation. Wood's lamp examination however showed accentuation of the hypopigmented lesions.

Based on history this is most likely post inflammatory. Other differential considered includes vitiligo. Vitiligo is probably unlikely in this patient as the hypopigmentation developed after he had eczema with secondary infection of the hands and feet.

Any suggestions for this hypopigmentation? Would UVB or tacrolimus ointment help?

Thanks for your comments.



3 comments:

  1. Dr.Abbas AlshammariJuly 20, 2006

    I think,in addition to the postinflammatory hypopigmentation,the possibility of poststeroid leucoderma should be considered.In such cases UVB or topical psoralen plus UVA would be preferable to others.

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  2. The hypopigmentation here does not look like pityriasis alba. It could be secondary to monobenzylether of hydroquinone in rubber products or other sources. I would also like to rule out vitiligo. Have you done a Wood's light exam to see if it is complete depigmentation? I have seen cases like this from chemicals such as colour developers and certain cleaning solutions. Please give some follow-up.

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  3. I think taht UVB is beter for it, but their is problem with photographic therapy that use of UV alone may could be dangerous and there is high risk for cancer as I recently read from a vitiligo site , so take care about it. So I think first check tacrolimus ointment first.

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