Hypopigmented mycosis fungoides in a 10yearold boy a manzur, s t h zaidi dermatology online journal 12 6. A case of hypopigmented mycosis fungoides successfully. Differential diagnosis should include atopic dermatitis, pityriasis alba, leprosy. Secondly, the range of the differential diagnosis is broad and histological. A differential diagnosis is carotenaemia, in which the skin colour takes on a yelloworange. The epidermal infiltrate in hypopigmented mf is reported to be predominantly of cd8positive lymphocytes 11,12, however, our patient had an epidermal infiltrate with mostly cd4positive lymphocytes. When evaluating a patient with hyperpigmented lesions, there is a broad differential, and the diagnosis of exogenous ochronosis may only be elicited with a good medication. Pityriasis alba is characterized by patches of indistinct hypopigmentation and scaling, often on the face or extremities. Pityriasis alba is most common in children ages 316, although it can be seen in infants, especially those with chronic dry skin or a diagnosis of eczema. Patients may occasionally provide selftaken digital images of skin lesions or eruptions.
Five patients with type v skin were studied to describe the clinical manifestations, pathological features, and treatment response in hypopigmented mycosis fungoides hmf. Then, the lesions gradually increased in size and progressed to involve almost wholebody sparing face. Moreover, the differential diagnosis includes several benign skin disorders. A punch biopsy from a hypopigmented patch showed typical features of mf lymphocytic in.
The differential diagnosis of vitiligo includes nevus depigmentosus. He denies any recent travel or close contact with persons or animals having a similar eruption. Hypopigmented mycosis fungoides should be regarded as a subtype of mycosis fungoides, insofar as it presents some peculiar characteristics that contrast with the clinical features of the classical form. When faced with a patient with hypopigmented macules, the differential diagnosis should include tinea versicolor, pityriasis alba, vitiligo, tuberculoid leprosy, and idiopathic guttate hypomelanosis. At first, a few lesions appeared over both knees 1year ago. Melanin is carried by keratinocytes to the skin surface. The differential diagnosis of localized hypomelanoses in children figure 2 can be based on the distinction between depigmentation and hypopigmentation, using woods light examination. Furthermore, a careful medical history of the approximate time of onset can be helpful in differentiating congenital e. Hypopigmentation refers to patches of skin that are lighter than your overall skin. These lesions eventually subside, leaving hypopigmented areas that then slowly return to normal pigmentation see the images below. Clinicopathological correlation of acquired hypopigmentary disorders anisha b patel 1, raj kubba 2. The most common locations for pityriasis alba include. Hypopigmented patches on the skin dermatology jama.
Proper diagnosis of these common skin conditions will allow the physician to facilitate appropriate skin. A concise approach to childhood hypopigmentation ncbi. In 1953, degos divided parapsoriasis en plaques into two forms. Patch or plaque stage lesions of mf are characterised by a. The hypopigmentation due to inflammatory skin disorders and infections usually. The diagnosis of hps is made on clinical findings of oculocutaneous albinism, bleeding diathesis, and absence of dense bodies on electron microscopy of platelets. Here you can access the flashcards form developmental abnormalities. The following list of conditions have hypopigmented patches of skin or similar listed as a symptom in our database. Bier spots on legs associated with deep vein thrombosis during. I noticed a hypopigmented patch, slightly elevated near the right angle of my mouth a couple days back.
The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin. Case report childhood hypopigmented mycosis fungoides. Her main concern involves discoloration of her back and chest that has been present for the past few months. Typical lesions show raised erythematous orange to yellow plaques. A 47yearold man presents with a 1year history of a mildly pruritic eruption on the trunk and extremities. Diagnostic checklist, medical tests, doctor questions, and related signs or symptoms for hypopigmented patches of skin. A hypopigmented patch on a 7yearolds back alexander k. The prognosis for hypopigmented mycosis fungoides is much better than for classical mycosis fungoides. Patient evaluation the initial patient evaluation involves a detailed family and personal history and a complete physical examination, which should include a careful search for additional cutaneous and extracutaneous signs and symptoms. Children and infants at higher risk for this condition include those with asthma, hay fever, eczema, and dry skin.
Differential diagnosis nevus depigmentosus should be differentiated from congen. Adolescent female presents with discoloration on her back. Physical examination showed widespread hypopigmented patches involving the face, trunk, and limbs. White skin localised localised white skin lesions also signify a limited number of diseases. Symptom checker conditions listing medical symptoms. The following causes of hypopigmented patches of skin appear in the population at a rate of substantially less than 200,000 people per year in the usa. The patient had not sought prior treatment for the discoloration and denied any previous rash or trauma to the area. It presents as flat, scaly and hypopigmented patches and sometimes with a. Differential diagnosis of hypopigmented skin lesions january 24, 2019 december 19, 2018 vitiligo the degree of hypopigmentation is greater and the distribution is frequently different with vitiligo involving the hands and face. The differential diagnosis of pale dry patches on the face or limb of a child includes.
Disorders of hyperpigmentation and melanocytes clinical gate. Hypopigmented macules and patches clinical advisor. Clinicopathological correlation of acquired hypopigmentary. Hmf should be included in the differential diagnosis of any persistent hypopigmented macule or patch that is resistant to treatment. Pityriasis alba, a relatively common skin disorder in children and young adults, is characterized by the presence of illdefined, scaly, faintly erythematous patches. Infectious diseases in children a 15yearold female presents for her wellchild visit.
The differential diagnosis of hypopigmentation disorders is illustrated in the. Acquired hypopigmentation disorders other than vitiligo uptodate. Differential diagnosis conditions to include in the differential diagnosis in a child. Levin basics description lesions characterized by reduced or absent pigment in or absence of the retinal pigmented epithelium or choroid present at birth. If dark patches are observed, the main diagnoses to consider are. In this article, learn about the different types of hypopigmentation, including albinism and vitiligo, as well as why these conditions occur. Differential diagnosis conditions to include in the differential diagnosis in a child of this age include the following.
Other entities in the clinical differential diagnosis include pityriasis alba, tinea versicolor, leprosy, and post kalaazar. Differential diagnosis of hyper and hypopigmentation. Anhidrosis and hypopigmented patches of skin symptom. The differential diagnosis is challenging as tfi resemble many other dermatologic conditions. He has no significant medical history and takes no medications. Causes of hypopigmented patches of skin that are very rare. In many cases, the patient general may reveal a lesion or eruption of which the patient may be unaware. This is the card info for the flashcard a boy comes from bihar with nonanesthetic hypopigmented atrophic patch over face, diagnosis is lq a p. Pityriasis alba is characterized by oval but poorly demarcated, slightly scaly, hypopigmented macules or patches located on the face typically the cheeks, upper trunk, or extensor surfaces of the arms fig. Jazan afp differential diagnosis of hypopigmented skin. Common pigmentation disorders american family physician. The differential diagnosis of nd includes ashleaf spot of tuberous sclerosis, indeterminate leprosy, seborrheic dermatitis, lichen striatus. Most causes of hypopigmentation are not serious and can be easily treated.
This is a case of asymptomatic hypopigmented patches on a man. 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. Primary cutaneous lymphomas pcls are exceedingly rare in children and adolescents, with mycosis fungoides mf being the most frequent pcl diagnosed in childhood. In this rare form, hypopigmented macules are distributed mainly on the face, and the back has been recently reported. See full list of possible disease causes of hypopigmented patches of skin hypopigmented patches of skin. The hypopigmentation was more visible following sun exposure because the areas did not tan. The face, hands, forearms, chest, back and shins are the most common locations, erupting. Hypopigmentation can be upsetting to some, especially those with darker skin whose hypopigmentation marks are seen more visibly. These lesions eventually subside, leaving hypopigmented areas that then slowly return to. A 39yearold woman presented with 2 areas of hypopigmented discoloration on the left thigh of 6 months duration. Hypopigmented discoloration on the thigh mdedge dermatology. List of 29 causes for anhidrosis and hypopigmented patches of skin, alternative diagnoses, rare causes, misdiagnoses, patient stories, and much more.
Diagnostic checklist, medical tests, doctor questions, and. The differential diagnosis of hypopigmentation disorders is illustrated in the algorithm algorithm 1. Mycosis fungoides mf is the most common primary cutaneous t cell lymphoma, which is characterised in its early stages by epidermotropism of small to mediumsized t lymphocytes with cerebriform nuclei. 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. The differential diagnosis includes the griscelli, elejalde and cross syndromes. These flash cards come under dermatology which is a part of dr. Hypopigmented and scaly lesions on a boys cheek medicine today. 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. Your skin s pigmentation, or color, is based on the production of a substance called melanin.
Your skins pigmentation, or color, is based on the production of a substance called melanin. Hypopigmented macules on the face and neck of a man. A boy comes from bihar with nonanesthetic hypopigmented. Postinflammatory hypopigmentation, in which there is a history of another inflammatory skin disorder. Hmf is exceptional overall, but comparatively common among children. Differential diagnosis includes confluent and reticulated papillomatosis, seborrheic dermatitis, pityriasis rosea, pityriasis alba, and vitiligo. List of 11 disease causes of hypopigmented patches of skin, patient stories, diagnostic guides. A 22yearold korean woman presented with a 1year history of progressive, asymptomatic hypopigmented patches on trunk and extremities. Hypopigmentation refers to patches of skin that are lighter than your overall skin tone. The lesions appear mainly on the face, especially the cheeks and upper arms.
Tinea versicolor, also known as pityriasis versicolor, is a benign, chronic discoloration of the skin caused by the proliferation of yeast. Her mother reported that both lesions were asymptomatic, had been present since birth, and were enlarging in proportion to her general body growth. Case presentation a 6yearold boy presents with hypopigmented and slightly scaly lesions on his cheeks that were first noticed two months earlier figure. The melanocytes of darkskinned people produce more melanin than those of people with light skin. A skin biopsy of tinea versicolor is characterized by lymphocytes around the dermal vasculature, mild epidermal hyperkeratosis, and acanthosis. The patches are oval in shape and have spared other parts of the body. I havent lost any sensation in that area, but it feels a little different when i touch compared to the opposite side. Pigmentation disorders are often more troublesome in skin of colour. Skin patches were limited to sunlightcovered body areas. However, given the persistence and progression of the skin lesions, the patient was submitted to biopsy from a hypopigmented patch that showed typical features of hypopigmented mf. Atopic dermatitis, characterised by very itchy symmetrical plaques that respond to topical steroids.