Hypopigmented Lesions in Children
Hypopigmented Lesions in Pediatrics
Overview
Hypopigmented lesions represent areas of decreased melanin production or transfer, resulting in lighter-colored patches compared to surrounding skin. These lesions are common in children and can be congenital or acquired.
Key Points
- Variable prevalence based on condition
- May be isolated or part of systemic disease
- Can significantly impact quality of life
- Some forms have genetic predisposition
- May be progressive or static
Basic Pathophysiology
- Decreased melanin synthesis
- Reduced melanocyte number
- Impaired melanin transfer
- Destruction of melanocytes
Classification of Hypopigmented Disorders
By Onset
- Congenital
- Piebaldism
- Waardenburg syndrome
- Tuberous sclerosis
- Hypomelanosis of Ito
- Acquired
- Vitiligo
- Post-inflammatory hypopigmentation
- Tinea versicolor
- Pityriasis alba
By Distribution
- Localized
- Nevus depigmentosus
- Post-inflammatory changes
- Segmental vitiligo
- Generalized
- Albinism
- Generalized vitiligo
- Hypopigmentation in systemic disease
By Mechanism
- Melanocyte Absence/Dysfunction
- Melanin Synthesis Defects
- Melanin Transfer Problems
- Post-inflammatory Changes
Common Hypopigmented Conditions
1. Vitiligo
- Features
- Well-defined depigmented patches
- Complete absence of melanocytes
- Wood's lamp enhancement
- Often symmetric distribution
- Types
- Nonsegmental (most common)
- Segmental
- Mixed
- Universal
2. Pityriasis Alba
- Characteristics
- Ill-defined hypopigmented patches
- Fine scale
- Face predominance
- Associated with atopy
3. Tinea Versicolor
- Features
- Caused by Malassezia furfur
- Fine scale
- Truncal predominance
- KOH examination positive
4. Post-inflammatory Hypopigmentation
- Causes
- Eczema
- Psoriasis
- Burns
- Infections
5. Nevus Depigmentosus
- Characteristics
- Present at birth/early infancy
- Stable size and shape
- Serrated borders
- No wood's lamp enhancement
Diagnostic Approach
History Taking
- Key Questions
- Age of onset
- Rate of progression
- Family history
- Associated symptoms
- Prior treatments
- Associated Conditions
- Autoimmune diseases
- Atopic conditions
- Neurological symptoms
- Visual/hearing problems
Physical Examination
- Skin Examination
- Distribution pattern
- Border characteristics
- Associated features
- Wood's lamp examination
- System Review
- Neurological assessment
- Eye examination
- Hair and nail changes
- Growth parameters
Laboratory Studies
- Basic Workup
- KOH preparation when indicated
- Skin biopsy (selected cases)
- Autoimmune screening
- Thyroid function tests
Management Approaches
General Principles
- Accurate diagnosis essential
- Treatment based on cause
- Combination therapy often needed
- Regular monitoring important
Specific Treatments
- Topical Agents
- Corticosteroids
- Calcineurin inhibitors
- Antifungal medications
- Emollients
- Phototherapy
- Narrow-band UVB
- PUVA (in selected cases)
- Targeted phototherapy
- Systemic Treatments
- Oral antifungals
- Systemic corticosteroids
- Immunomodulators
Supportive Measures
- Sun protection
- Camouflage techniques
- Psychological support
- Patient education
Associated Syndromes and Conditions
Genetic Syndromes
- Tuberous Sclerosis
- Ash leaf spots
- CNS manifestations
- Cardiac rhabdomyomas
- Waardenburg Syndrome
- White forelock
- Heterochromia
- Hearing loss
Autoimmune Associations
- Autoimmune thyroid disease
- Type 1 diabetes
- Celiac disease
- Alopecia areata
Special Considerations
Age-Specific Concerns
- Infants
- Differentiation from birthmarks
- Syndromic associations
- Parent education
- School-Age Children
- Psychosocial impact
- School support
- Peer relationships
- Adolescents
- Body image concerns
- Treatment compliance
- Career counseling
Quality of Life Impact
- Psychological effects
- Social interactions
- Academic performance
- Future career choices
Prevention Strategies
- Sun protection
- Early intervention
- Regular monitoring
- Family support
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
