Thursday, September 26, 2019

Hypopigmented Macules in a Child

The patient is a 4 1/2-year-old boy who is seen today for evaluation of hypopigmented macules on the arms and legs for less than a week. His parents first notice this four or five days ago. He has been in his usual state of health although two days ago he developed a fever to 104.7  and was seen by his pediatrician who felt it was a viral syndrome. Throat culture was negative for strep.

On examination: This is a healthy appearing child. He does have a raspy cough. He has 5 to 7 mm in diameter hyperpigmented macules scattered over the arms and legs. Some of these lesions have a so much angular outline.

The patient's mother is a neighbor who lives about a one minute walk from my house, so they walked over and I took a look.

My initial thoughts are that this may be the onset of vitiligo,  The lesions are larger than itiopathic guttate hypomelanosis; but if this occurs in children it must be very rare. 
Your thoughts will be appreciated.  Should any tests be done at this time?

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