The differential diagnosis of pale dry patches on the face or limb of a child includes. Differential diagnosis conditions to include in the differential diagnosis in a child of. Hypopigmented macules secondary to imatinib for the treatment of. Cutaneous tcell lymphoma is a term that was created in 1979 at an international workshop sponsored by the national cancer institute nci to describe a group of lymphoproliferative disorders characterized by localization of neoplastic t lymphocytes to the skin. Pruritus of variable intensity may also be present. The differential diagnosis of calm includes a congenital melanocytic nevus, speckled lentiginous nevus, lentigo, beckers nevus and forms of pigmentary mosaicism such as nevoid hypermelanosis. The melanocytes of darkskinned people produce more melanin than those of people with light skin.
The following list of conditions have hypopigmented patches of skin or similar listed as a symptom in our database. Differential diagnosis of hyper and hypopigmentation. Differential diagnosis nevus depigmentosus should be differentiated from congenital causes of depigmentation and other congenital causes of hypopigmentation. This is not to be confused with depigmentation, which is characterized as the absence of all pigment. Such light patches can occur at birth or in early infancy. Differential diagnosis should include pityriasis alba, progressive macular hypomelanosis, leprosy, vitiligo, idiopathic guttate hypomelanosis. Undertreated psoriasis or eczema of the trunk may also present as hypopigmented patches but some evidence of these conditions elsewhere should allow you to make the diagnosis. Oval ash leaf hypopigmented macules are the earliest cutaneous sign of tuberous sclerosis. Mycosis fungoides mf is a clinical diagnosis that requires strong correlation with histopathologic and sometimes molecular findings to exclude benign inflammatory diseases, more aggressive primary cutaneous lymphomas, and extracutaneous lymphomas that can involve the skin. Originally described by alibert in 1806, mf is classically a disease of adults, although children and adolescents can be affected, and it typically has a protracted, indolent course.
This might be attributed to under diagnosis of the condition, because the patients with hypopigmented mf are likely to remain undiagnosed or receive alternative diagnoses such as vitiligo, atopic dermatitis, chronic lichenoid dermatitis, or postinflammatory hypopigmentation. Differential diagnosis conditions to include in the differential diagnosis include the following. The differential diagnosis includes tinea versicolor, early vitiligo, postinflammatory hypopigmentation, and nevus depigmentosus. For lymphomas in general, the skin is actually the second most common extranodal. Occasionally, the condition begins as mildly itchy, pink patches that develop into hypopigmented patches. This is a case of asymptomatic hypopigmented patches on a man. The clinical differential diagnosis for hypopigmented mf includes the early inflammatory stage of vitiligo, postinflammatory hypopigmentation, lichen sclerosus, pityriasis alba, and leprosy. It is caused by melanocyte or melanin depletion, or a decrease in the amino acid tyrosine, which is used by melanocytes to make melanin. Other entities in the clinical differential diagnosis include. Immunohistochemistry generally is helpful in distinguishing between classical mf and hypopigmented mf. Mycosis fungoides variantsclinicopathologic features. The macules are well circumscribed and each has a central raised lesion.
A 55yearold white man presented with multiple hypopigmented macules, mainly on both forearms and shins, which had been present for several years. He denies any recent travel or close contact with persons or animals having a similar eruption. Differential diagnosis conditions to include in the differential diagnosis in a child of this age include the following. On physical examination, he has hypopigmented round patches with fine cigarettepaper scaling centrally located on his proximal arms, hips, thighs, lateral chest wall, and flanks.
Cafeaulait macules are amenable to surgical excision or laser treatment. When evaluating a patient with hyperpigmented lesions, there is a broad differential, and the diagnosis of. Your skins pigmentation, or color, is based on the production of a substance called melanin. Hypopigmented mycosis fungoides is also in the differential diagnosis, but this is an extremely rare condition less than one case per 4 million persons per year. Folliculotropic mf fmf is a distinct variant of mf characterized by the presence of. Hypopigmentation is the loss of skin pigment or color. Hypopigmented mycosis fungoides tends to occur in young, slightly to moderately darkskinned people of indian, latin american, or subsaharan african american heritage. Idiopathic guttate hypomelanosis igh is a common benign skin condition. Melanin is carried by keratinocytes to the skin surface.
Pityriasis alba differential diagnoses medscape reference. Nevus depigmentosus, which undoubtedly also results from genetic mosaicism, is characterized by welldemarcated hypopigmented macules or patches, which are often unilateral and localized. Disorders of hyperpigmentation and melanocytes clinical gate. Case presentation a 6yearold boy presents with hypopigmented and slightly scaly lesions on his cheeks that were first noticed two months earlier figure. The hypopigmentation due to inflammatory skin disorders and infections usually.
Pigmentation disorders are often more troublesome in skin of colour. The patches may have slight and subtle surface patches scale. Approach to reticulate hyperpigmentation vachiramon. There are many patterns of distribution, including acral, flexural, truncal and facial. People often think that pityriasis alba gets worse in the summer, but it just becomes more obvious as the normal, surrounding skin becomes darker with sun exposure. These lesions eventually subside, leaving hypopigmented areas that then slowly return to. Localised morphea or lichen sclerosus can also present as hypopigmented patches but the underlying skin will be firm in morphea. Case presentation a 7yearold girl presents with a small number of hypopigmented macules on her back that have been present for about three months figure 1. Hypopigmentation refers to patches of skin that are lighter than your overall skin tone. The differential diagnosis of pityriasis alba includes the following. A hypopigmented patch on a 7yearolds back alexander k.
The differential diagnosis of hypopigmented lesions of tinea versicolor includes vitiligo, hypopigmented mycosis fungoides, progressive macular hypomelanosis pmh. Hypopigmented patches on the skin dermatology jama. Postinflammatory hypopigmentation hypopigmented patches and plaques in a patient with cutaneous tcell lymphoma. These lesions eventually subside, leaving hypopigmented areas that then slowly return to normal pigmentation see the images below. Asymptomatic hypopigmented macules on the trunk and limbs of a. Although most hyperpigmented lesions are benign and the diagnosis is. Distinctive skin manifestations of hmf include hypopigmented toachromic lesions, of variable sizes, which are often confined to the trunk, buttocks, pelvic girdle, and lower limbs, albeit any body surface may be affected. However, the pigment loss is rarely complete, as it is in vitiligo. The differential diagnosis of localized hypomelanoses in children figure 2 can be based on the distinction between depigmentation and hypopigmentation, using woods light examination. White macular lesions on a girls back medicine today. Common pigmentation disorders american family physician. Pityriasis alba pa, a very common disease, was considered the most likely diagnosis during the first clinical observations, when the patient presented fewer hypopigmented lesions.
List of 29 causes for anhidrosis and hypopigmented patches of skin, alternative diagnoses, rare causes, misdiagnoses, patient stories, and much more. Some of the lesions coalesce to form irregularly shaped patches. Reticulate hyperpigmentation with onset in adolescents and adults. Hypopigmented discoloration on the thigh mdedge dermatology. Hypopigmentation may persist for months, even after lesions are treated, and takes time to resolve.
Common causes of hyperpigmented patches of skin symptom from a list of 28 total causes of symptom hyperpigmented patches of skin. List of 11 disease causes of hypopigmented patches of skin, patient stories, diagnostic guides. Symptom checker conditions listing medical symptoms. The lesions on the extremities were predominantly on the proximal parts specially the dorsal aspect of the thigh and gluteal region fig.
The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin. Hypopigmentation disorders may be congenital or acquired, diffuse generalized or localized, and may occur in isolation or be associated with a wide range of congenital or acquired disorders. The differential diagnosis of hypopigmentation disorders is illustrated in. Anhidrosis and hypopigmented patches of skin right diagnosis. Differential diagnosis of hyper and hypopigmentation hyperpigmentation postinflammatory hyperpigmentation acne, psoriasis, atopic and contact dermatitis, lichen planus, trauma, drugs, and fixed. The differential diagnosis of localized nonlinear lesions includes ash leaf macules in tuberous sclerosis, nevus depigmentosus, postinflammatory. Hypopigmented mf, which is the most common variant in childhood and adolescence, and other rare variants are shortly discussed. Nevus depigmentosus is indistinguishable from the ash leaf macules and confetti. The differential diagnosis of localized nonlinear lesions includes ash leaf macules in tuberous sclerosis, nevus depigmentosus, postinflammatory hypopigmentation, pityriasis alba, pityriasis versicolour, hypopigmented mycosis fungoides, tuberculoid leprosy, hypopigmented sarcoidosis, leucoderma at sites of vaccination, cryothrapy for warts as. Asymptomatic hypopigmented macules and patches mdedge. The childs father and paternal grandmother had similar skin findings.
In localized hypopigmentation, there may be multiple patches or areas on the skin that appear. Furthermore, a careful medical history of the approximate time of onset can be helpful in differentiating congenital e. Postinflammatory hypopigmentation may be confused with vitiligo, particularly when hypopigmentation is profound. Pityriasis alba, a relatively common skin disorder in children and young adults, is characterized by the presence of illdefined, scaly, faintly erythematous patches.
It appears as multiple round or oval macules of depigmentation or hypopigmentation, mostly over the upper or lower. Trunk lesions were more located on the lower part of the abdomen around the umbilicus and flanks fig. On examination, faint hypopigmented macules and patches with areas of fine scale are noted. Hypopigmented macules and patches clinical advisor. See full list of possible disease causes of hypopigmented patches of skin hypopigmented patches of skin. Acquired hypopigmentation disorders other than vitiligo uptodate. Hypopigmentation is characterized specifically as an area of skin becoming lighter than the baseline skin color, but not completely devoid of pigment.
If dark patches are observed, the main diagnoses to consider are. Diagnostic checklist, medical tests, doctor questions, and related signs or symptoms for hypopigmented patches. A differential diagnosis is carotenaemia, in which the skin colour takes on a yelloworange. The hypopigmented patches were asymptomatic, and the pigmentary pattern had been noted at birth. The differential diagnosis for acquired hypopigmented patches in children includes pityriasis versicolor truncal distribution with pink to hyper or hypopigmented patches.
These lesions eventually subside, leaving hypopigmented areas that then. What is the clinical history of hypopigmented mycosis. Postinflammatory hypopigmentation, in which there is a history of another inflammatory skin disorder. Erythematous scaly patches and plaques on the trunk and. A practical classification of childhood hypopigmentation disorders.
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