Tuesday, October 21, 2008

Hypopigmentation in a Young Child

Presented by Dr. Henry Foong
Ipoh, Malaysia

History: A 6 year old boy presented with patches of hypopigmentation on the trunk and extremities since one year's of age. It was occasionally pruritic. He is otherwise well and has no history of fever or other constitutional symptoms. There was no family history of similar problem and no personal or family history of atopy.

Examination showed the skin was quite dry. Multiple irregular patches of hypopigmentation 2-4 cm diameter were distributed over the back of trunk involving both the lower back extending to the gluteal areas, the arms and anterior chest wall. Sensation was normal in the affected areas.

Photos:































Lab: KOH examination did not reveal hyphae or spores.
Pathology: Biopsy not performed as yet.

Diagnosis: ? Progressive Macular Hypopigmentation ? Pityriasis Alba

Questions: Have you seen this in a young child?? What is your diagnosis and therapeutic recommendations.

Reference:
Progressive macular hypomelanosis: an overview.
Relyveld GN, Menke HE, Westerhof W.
Am J Clin Dermatol. 2007;8(1):13-9.
The Netherlands Institute for Pigment Disorders, Academic Medical Center,
University of Amsterdam, Amsterdam, The Netherlands.



5 comments:

  1. aisha sethiOctober 22, 2008

    Dear Henry,

    Thank you for this case. Would biopsy definitely to rule out hypopigmented MF - have seen a few cases here on the south side of Chicago.

    Best,

    Aisha Sethi

    ReplyDelete
  2. Ashok K. SharmaOctober 24, 2008

    Progressive macular hypopigmentation (PMH) is the most probable diagnosis for this patient. Hypopigmented MF would be a valid differential however I have seen almost all of my cases in post-childhood age-group.In patients from endemic areas, Post-Kala Azaar Dermal Leishmaniasis may also manifest with such hypopigmented ill-defined lesions. Wood's light examination (to look for the fluorescence sometimes seen in PMH) and biopsy would clarify matters. Expectant management apart from the use of moisturizers seems the only practicable therapeutic plan for such children.

    ReplyDelete
  3. Intresting case,histopathological biopsy should be done to exclude two other possibilities (1)wide spread patches of nevus depigmentosus (2)hypomelanosis of Ito(high percentage of self repigmented at age of 8-10years.)
    firas altamimi

    ReplyDelete
  4. A skin biopsy was done on the lower trunk. It did not show any remarkable changes in the epidermis or dermis. There was no epidermotropism to suggest mycosis fungoides. Our impression is progressive macular hypopigmentation. Though biopsy is negative, we thought this is a good idea to follow up the patient closely.

    ReplyDelete
  5. AnonymousMay 20, 2009

    May I recommend you obscure this young boys face, so as to avoid future embarrassment.

    ReplyDelete

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