Parentalguardian consent was obtained for publication of this figure. Cases have been reported in both the first and second decades of life. Hypopigmentation is common and approximately one in twenty have at least one hypopigmented macule. Hypopigmented mycosis fungoides hmf is an atypical, rare and unique variant of mycosis fungoides characterized by solely hypopigmented patches or in combination with erythematous patches or plaques. Therapies include sodium stibogluconate, amphotericin b andor paromomycin. The rash has a geometric pattern in areas of occlusion ie, under leads and wires and maceration with white exudate in the axillae fig 1. There are a whole range of treatment approaches available. Neonate with a hypopigmented rash american academy of. Sun exposure may increase the contrast with normal skin, prompting patients. If you have a skin lesion or many that is flat and less than 1 cm in size, and want to find out whats. Hypopigmentation white or lighter areas of skin colour. Macules may be a sign of something serious or mean absolutely nothing at all.
Disorders of hypopigmentation may also pose diagnostic challenges. Management is similar to hmf, and if treated with narrowband uvb phototherapy, it can resolve within two years. Causes of hypopigmented patches of skin without any prevalence information. A 55yearold white man presented with multiple hypopigmented macules, mainly on both forearms and shins, which had been present for several years. Early ctcl often lacks the histologic criteria necessary for a definitive diagnosis. The shagreen patch, a fleshy, irregular plaque often found on the. The problem is it can take months without additional treatment. Tinea versicolor tv, or pityriasis versicolor, is a noninflammatory, superficial cutaneous fungal infection caused by malassezia furfur, also known as pityrosporum orbiculare or p. Physical examination revealed multiple, welldemarcated, hypopigmented 1 to 5mm macules on the lower abdomen and pubic area figure, a and b. A 52yearold african american woman sought care for a hypopigmented rash that shed had for 7 months. Hypopigmented mf presents with hypopigmented macules and patches. It presents with perioral hypopigmented macules that converge into irregular patches to spread to the malar region, forehead and scalp. Hydroquinone is actually a skin whitening agent, but it has been used to help blend hypopigmented areas in to the skins natural surrounding color. Well to illdefined hypopigmented macules with smooth.
Lesions were also present on her upper extremities and. They may be hypopigmented lighter than the surrounding skin, hyperpigmented darker than the surrounding skins, or appear pink or red. Extensive pityriasis alba is believed to be a primary, acquired hypopigmentation observed in females aged 1825 years of mixed ethnic origin. List of 11 disease causes of hypopigmented patches of skin, patient stories, diagnostic guides.
The patches may have slight and subtle surface patches scale. Oval ash leaf hypopigmented macules are the earliest cutaneous sign of tuberous sclerosis. Hypopigmented lichen striatus with minimal papules has been termed lichen striatus albus. 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. Dermoscopy of hypopigmented lesions in children full. For people with darker skin, hypopigmentation may also result in stigma. Pigmentation disorders are often more troublesome in skin of colour. Such light patches can occur at birth or in early infancy.
Causes of hypopigmented patches of skin that are very rare. Jun 06, 2016 hypopigmented, finely scaled macules and patches on the trunk and extremities of darkerskinned individuals have a wide clinical differential diagnosis in a dermatologic encounter. Lesions consist of scaly hyper andor hypopigmented macules that coalesce into patches. Achromic naevus is an uncommon birthmark characterised by a welldefined pale patch. A preterm male infant in the nicu develops a rash with erythematous and hypopigmented macules, patches, and papules of the arms, axillae, neck, upper back, groin, and legs.
Figure 2 persistent smooth, hypopigmented patches of pityriasis alba on the face. Most commonly, this type of rash can be attributed to a benign etiology such as tinea versicolor, idiopathic guttate hypomelanosis, pityriasis alba, and vitiligo. Hypopigmented macules secondary to imatinib for the treatment of chronic. Dec 07, 2017 hypopigmentation refers to patches of skin that are lighter than your overall skin tone. Hypopigmented macules, also known as ashleaf spots, can be present at. Pubmed is a searchable database of medical literature and lists journal articles that discuss macules hereditary congenital hypopigmented and hyperpigmented. Nov 26, 2019 macule is just a word that doctors use to describe what they see on the skin. See detailed information below for a list of 11 causes of hypopigmented patches of skin, symptom checker, including diseases and drug side effect causes. Malassezia species are commensal flora of the skin and its colonization is established at birth and increases with age 4. A diffuse bluish patch that was suspected to be an aberrant mongolian spot surrounded the hypopigmented areas. Malassezia requires an oily environment for growth.
Nov 12, 2019 in its hyphal form, it produces skin lesions that appear as scaly, round or oval, hypopigmented, hyperpigmented, or pink macules or patches. They are one of the commonest complains in the dermatology clinics and generally share the same patient complaint which is characterized by the presence of hypo or depigmented patches or macules. The major function of this system is as a barrier against the external environment. Lesions consist of scaly hyper and or hypopigmented macules that coalesce into patches. Tinea versicolor tv, or pityriasis versicolor, is a noninflammatory, superficial cutaneous fungal infection caused by malassezia furfur. Hyperhidrosis is the most important predisposing factor. Hypopigmented, finely scaled macules and patches on the trunk and extremities of darkerskinned individuals have a wide clinical differential diagnosis in a dermatologic encounter. Treatment failure and disease relapse are common and difficult to differentiate from delayed repigmenation. It presents as flat, scaly and hypopigmented patches and. Aug 01, 2017 pubmed is a searchable database of medical literature and lists journal articles that discuss macules hereditary congenital hypopigmented and hyperpigmented. Hypo pigmented skin lesions are commonly encountered in daytoday practice, and they pose a diagnostic challenge for the clinician.
Check the full list of possible causes and conditions now. A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary systemthe organ system that encloses the body and includes skin, hair, nails, and related muscle and glands. The disease has predilection for darkskinned individuals. This clinical variant of the classic pityriasis alba cpa is most common among children, and it is characterized by hypopigmented macules and. A child with multiple hypopigmented macules on the abdomen.
Progressive macular hypomelanosis of note, there are subsets of lichen striatus. These include granulomatous, pustular, purpuric, hyperkeratotic and verrucous, bullous, invisible, and. Hypopigmentation is the loss of skin color due to a disease or trauma. Hypopigmentation refers to patches of skin that are lighter than your overall skin tone. Lesions coalesced into patches over the midline back. Occasionally, the condition begins as mildly itchy, pink patches that develop into hypopigmented patches.
A child presented with multiple, asymptomatic, scattered white macules on the lower abdomen and pubic area, which were present at birth and had gradually increased in size and number. In its hyphal form, it produces skin lesions that appear as scaly, round or oval, hypopigmented, hyperpigmented, or pink macules or patches. Hypopigmentation can be upsetting, particularly if visible. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Most causes of hypopigmentation are not serious and can be easily treated. Mf is an uncommon clinical variant of mf characterized by hypopigmented macules. The idea being to lessen the contrast between the two areas.
These lesions eventually subside, leaving hypopigmented areas that then slowly return to. However, they are also common in the general population, which raises the question of when a patient with one or more hypopigmented macules should be evaluated for ts. Hypopigmented macules jama dermatology jama network. Amelanotic macules or patches surrounded by normal skin with discrete, usually convex, margins. Around 1 in 20 people have at least one hypopigmented macule. Indolent hypopigmented interface tcell dyscrasia the. These spots began appearing about 7 months earlier and were asymptomatic. Hypopigmentation can be upsetting to some, especially those with darker skin whose hypopigmentation marks are seen more visibly. An infant with hypopigmented macule photo quiz american. Pityriasis alba, a relatively common skin disorder in children and young adults, is characterized by the presence of illdefined, scaly, faintly erythematous patches. On examination, faint hypopigmented macules and patches with areas of fine scale are noted.
Hypopigmented definition of hypopigmented by medical dictionary. Spontaneous disappearance of hypopigmented macules and patches. 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. A woods light examination highlights the macules and helps to identify them in fairskinned patients.
The condition is unusual in children but when it occurs the lesions are usually on the face unlike in adults, for whom the lesions are most commonly on the torso. As with many things, laser therapy can be both cure and cause. The melanocytes of darkskinned people produce more melanin than those of people with light skin. Mf is an uncommon clinical variant of mf characterized by hypopigmented macules and papules without atrophy fig. Dec 04, 2017 hypopigmentation is the loss of skin color due to a disease or trauma. The distribution is patchy and there are often large numbers of macules that can coalesce and produce larger lesions. Report of a case a 68yearold black woman complained of an increasing number of white spots on her arms and legs. Note the characteristic, illdefined, hypopigmented macules in this. Asymptomatic hypopigmented macules on the trunk and limbs of a.
The physical examination revealed numerous hypopigmented macules on her thighs figs 1 and 2. The patient indicated that she had evacuated new orleans following hurricane katrina by wading through polluted waters for hours before being rescued. Its course is indolent for several years and thus source of delayed diagnosis. 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. Asymptomatic hypopigmented macules and patches mdedge. The patient recalled that the lesions initially had begun approximately 10 years ago as a few small lighter areas on the extensor aspect of the forearms and shins. Some of the lesions coalesce to form irregularly shaped patches. In this article, learn about the different types of. Four days passed before she had access to a shower, and thats when. It usually presents as patches, plaques, nodules, or tumors although. This is usually several centimetres in diameter, with an irregular but welldefined border. Your skins pigmentation, or color, is based on the production of a substance called melanin. Diagnostic checklist, medical tests, doctor questions, and.
Hypopigmented macules and patches clinical advisor. A concise approach to childhood hypopigmentation ncbi. The rash was on her upper thighs and arms in a symmetric distribution. Hypopigmented lesions in a teenaged girl contemporary. Hypopigmented macules, also known as ashleaf spots, can be present at birth and are most common on. Apr 01, 2007 an infant with a hypopigmented macule. Hypopigmented macules are the earliest cutaneous finding in tuberous sclerosis ts. This area of decreased pigment hypopigmentation is referred to as an ash leaf macule and is seen with the inherited disorder, tuberous sclerosis. Conditions of the human integumentary system constitute a broad spectrum of diseases, also. Hypopigmented macules and patches in infants have a variety of etiologies such as pityriasis alba, nevus depigmentosus, nevus anemicus, ashleaf spot in tuberous sclerosis, and uncommonly, pv. Progressive macular hypomelanosis plastic surgery key. Progressive macular hypomelanosis pmh presents as asymptomatic, illdefined hypopigmented macules and patches on the trunk and back. In some people, these patches can appear all over the body. The condition is more commonly seen in warm climates or during the summer months.
Macules can be seen on any part of the body, but are most frequently found on the chest, back, face, and arms. Erythema, scale, and papules within these macules and patches are variable. The shagreen patch, a fleshy, irregular plaque often found on the lower back, is another characteristic finding in patients with tuberous sclerosis. Psep appears as smooth, oval or round hypopigmented macules or patches. Common pigmentation disorders american family physician. Acquired hypopigmentation disorders other than vitiligo uptodate. It can affect people from birth or develop later in life. Hypopigmented definition of hypopigmented by medical. In the case of illness or injury, the persons skin may change color, becoming darker hyperpigmentation or lighter hypopigmentation.
The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin. That is, you can sometimes end up with hypopigmented skin following certain laser treatments. This area of decreased pigment hypopigmentation is referred to as an ash leaf macule and is seen with the. Macule is just a word that doctors use to describe what they see on the skin. Lesions often occur on the head, neck, upper extremities, trunk, and buttocks. Often, smaller hypopigmented macules arise around the edges, resembling a splash of paint. Mycosis fungoides mf, the most common primary cutaneous tcell lymphoma, is a neoplasic disease characterized by classical noninfiltrated lesions patches, plaques, tumors, and erythrodermic stages. Malassezia species are commensal flora of the skin and its colonization is established at. White spots on legs causes and fast home remedies skincarederm. Click on the link to view a sample search on this topic. Hyperpigmented lesions may have a pink, tan, brown, violaceous, gray or black hue.