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.  

[tamizanin]

Could this be tinea versicolor? Pictures shown in the site below looks similar too

http://www.visualdxhealth.com/adult/tineaVersicolor.htm

In the above site they say it could be caused by Using corticosteroids (cortisone) and having humidity. We have put hydro-cortisone cream and the depigmentation happened afterwards and he always had saliva flowing round his mouth all the time during that times. How do we test for this condition?

[tamizanin]

Please read my above notes reg my son's condition too...

Today we had been to a dermatologist and according to him he calls it a vitiligo simply based on woodlight exam. Later we showed him 23 snaps taken at various stages (from 1-Feb-08 till date) of my son's condition and the fact that they start first as dry reddish flaky patches and then turns white. They clearly have less distinct borders. He then said it could be both and also mentioned that as far as he knows pityroisis alba will not show up in woodlight exam. Only in case of total depigmentation it would show up. He also prescribed "Protopic" 0.3%. He says skin biopsy is not required. I have lost confidence totally with this opinion too. "Protopic" has FDA warning for causing skin cancer and I also am not convinced that pityriasis alba wont show up in woodlight. Can you please provide your thoughts on this.

[BhumikaMD]

Hi,

Nothing can be said with surety without having a look at the lesions . You would need to see a skin specialist for a confirmed diagnosis. If the diagnosis turns out to be pityriasis -no treatment is required and the patches in time will settle. The redness, scale and itch if present may be managed with simple emollients and sometimes hydrocortisone, a weak steroid, is also used.

As the patches of pityriasis alba do not darken normally in sunlight, effective sun protection helps minimise the discrepancy in colouration against the surrounding normal skin. Cosmetic camouflage may be required.

Let us know if you need any other information.

Regards.

[tamizanin]

Your notes on narrowing the causes are very helpful. My son is now 1.5 yrs old and he has been having a similar problem as reported by above user "momofgirlz" for 6 months now. Initially we reported doctors in Morristown, NJ about his dry skin and they prescribed Hydrocortizone 1% for him as he seem to have eczema. However, the use of this cream totally bleached my son's face in places where applied and slowly he started developing reddish patches around his mouth that are very very dry and scaly and losing pigmentation. We stopped the use of this cream as soon as we discovered it has steroids and because of the changes in his complexion on the applied areas. The hypopigmented patches have less distinct spots. On a second opinion from doctors in Boston, MA they suspected it to be Vitiligo simply on the basis of Woodlight examination using UV light. Since they did not consider the fact that the affected areas first were reddish and totally dry we were certain that an infant would not get vitiligo and this is not in our gene from my wife's and my side. we took him to India for third opinion to a homeopathy doctor who prescribed "Pigmento" by charak which is an ayurvedic cream that helps produce melonin on the applied areas. He also prescribed "Extramune" a tablet/syrup that helps develop his immunity (just incase this pathces are as a result of vitiligo). During this summer the patches certainly stopped growing and the white patches shrinking. The winter is starting and we noticed that he is again getting newer reddish patches around his mouth and chin which is flaky and slowly turning white. We are applying "Eucerin", moisturizer, olive oil constantly over his face almost every hour to keep his skin wet and oily. But we are totally confused on what my son is going through. The Children's hospital in Boston is unable to provide us with appointment for the next 4 months even though we are fully insured. Looking at his history and upon reading your notes I suspect that my son seem to be having Pityriasis alba. Please advice what we should do.

Thanks

[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.

[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.