Pigmentation loss in a 3yr old

[momofgirlz]

My 3 yr old daughter is losing pigment all over her body.  She had a byopsy of the area and I was told she does not have vitilago.  They told me it was intermittent pigment loss and that was it.  I am going to get a second opinion but if any advice for me in the meantime would be appreciated.  

[BhumikaMD]

Hi,

'Distinguishing between hypopigmentation and depigmentation is crucial to narrowing the differential diagnosis. Hypopigmentation is a decrease in the level of pigmentation of the skin, whereas depigmentation is a total loss of skin pigment.'

Skin biopsies are helpful only rarely.

It would be best to consult a skin specialist and rule out the following causes in the case of your daughter -

' * Vitiligo
      –Affects 1% of the population
      –Begins as a focal or diffuse (more common) hypopigmented patch that  
        progresses to total loss of pigmentation of the affected skin (chalk white)
      –Usually symmetric; often tops of hands, perioral, periorbital skin, knees, elbows

    * Pityriasis alba
      –Very common, especially in black children
      –Less distinct borders than in vitiligo, does not result in complete depigmentation
      –Plaques may appear lighter than surrounding skin and may be scaly
      –Often secondary to mild inflammation, such as tinea versicolor or atopic eczema
      –Completely reversible and does not cause permanent hypopigmentation

    * Piebaldism
      –Congenital, permanent, and irreversible
      –Newborns often have a patch of white scalp hair and depigmented patches on the  
        trunk with normally pigmented patches within these larger depigmented areas

    * Chemical leukoderma (depigmentation)
      –May be caused by phenols, germicides, and many other caustic chemicals
      –Results in confetti-like macules of depigmentation in exposed skin

o Albinism
            –Congenital
            –Disorder of melanin synthesis with several phenotypes, ranging from  
              complete lack of pigmentation (white hair and translucent or “red” iris) to the  
              more common diffuse hypopigmentation or “yellow” albinism that is prevalent  
              in the black population
            –Affects the skin, hair, and eyes
            –Photophobia, decreased visual acuity, strabismus, and risk of skin cancer

  o Congenital birthmarks (e.g., nevus anemicus, nevus depigmentosis) are isolated patches of hypo- or depigmentation that remain unchanged over time

  o Tuberous sclerosis is an inherited systemic disorder that results in hypopigmented macules in the shape of an “ash leaf ” on the trunk, and confetti-type depigmented macules on the arms/legs.'

You could read about this in detail at the following links -
http://www.wrongdiagnosis.com/s/skin_conditions/book-diseases-2c.htm

and

http://www.dermatologyinfo.net/english/chapters/chapter38.htm

Let us know if you need any other information.

Post us about what the doctor advises.

Regards.

[momofgirlz]

Thanks so much for answering so quickly.  I didn't think there was such a thing as intermittent pigment loss.  I am taking her to a pediatric dermatologist up at childrens in Milwaukee.  Hopefully I will get a better answer there.  Thanks again from a concerned mom of 3.