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Common Pigmentation Problems in Children and Adolescents

Common Pigmentation Problems in Children and Adolescents - What it is

PITYRIASIS ALBA (PA)

Pityriasis alba is a common skin problem seen in children and adolescents. Many patients have a background or family history of atopic dermatitis/ eczema, allergic rhinitis or asthma.

PA occurs due to a mild dermatitis or eczema which subsequently leaves lighter areas of skin which is unable to tan after sun exposure. Many cases appear after sun exposure (especially after swimming), because of the contrast that results between normal skin that can tan and affected areas that cannot tan.

VITILIGO:

Vitiligo is an acquired form of decreased skin pigmentation. It results due to an immune reaction against pigment cells in the skin. The condition has a genetic basis and may affect several family members.

Vitiligo is fairly common, affecting about one percent of the population and can begin at any age.

Although most patients are otherwise healthy, a handful of patients may have other autoimmune disorders (eg. thyroid disease, diabetes).

PIGMENT MOSAICISM:

Pigment mosaicism refers to a group of skin conditions that present with either decreased (hypopigmentation) and/ or increased (hyperpigmentation) pigmentation of the skin.

Other names include "hypomelanosis of Ito", "linear and whorled nevoid hypermelanosis" and "nevus depigmentosus".

It is a fairly common condition that becomes apparent usually in infancy or early childhood.

Common Pigmentation Problems in Children and Adolescents - Symptoms

PITYRIASIS ALBA

PA appears as areas of lighter coloured skin, usually on the face and neck regions. A fine, dry scale may be seen on the surface of affected skin.



VITILIGO:

Vitiligo present as white, oval or linear shaped, flat skin areas, with well-defined borders. Hairs within the affected areas may also be white (poliosis).



The course of vitiligo is variable. Most patients present with only a few affected areas. Few patients may present with more extensively affected areas. The lesions may sometimes regain their colour spontaneously over months or years.

PIGMENT MOSAICISM:

Affected patients present with lighter or darker, flat patches of skin in a linear, streaky or “whorled” pattern. The patches tend to remain stable as the child grows.

Very rarely, the condition may be associated with problems with other organ systems (eg. bones, eyes or brain).

Common Pigmentation Problems in Children and Adolescents - How to prevent?

Common Pigmentation Problems in Children and Adolescents - Causes and Risk Factors

PITYRIASIS ALBA

Sun protection with the use of sunscreens (SPF 30 or more) and regular application of moisturisers can prevent worsening of the condition.

VITILIGO:

Trauma to the skin may induce lesions of vitiligo.

Common Pigmentation Problems in Children and Adolescents - Diagnosis

The diagnosis of pigment problems in children and adolescents is usually clinical. Sometimes the doctor may use a Wood's lamp to accentuate these areas of pigmentation. Very rare, a skin biopsy may be required to confirm the diagnosis.

Common Pigmentation Problems in Children and Adolescents - Treatments

PITYRIASIS ALBA

Treatment includes frequent use of moisturisers, and application of mild topical steroids or calcineurin inhibitors (eg. Elidel or Protopic) once or twice daily.

Sun protection with the use of sunscreens (SPF 30 or more) can prevent worsening of the condition.

VITILIGO:

Treatment options for children with vitiligo include:
  • Topical therapies (topical corticosteroids or topical calcineurin inhibitors eg. Elidel or Protopic)
  • Phototherapy (narrow band UVB, topical PUVA or Excimer laser)
  • Oral treatments (e.g. corticosteroids) may be attempted in patients with progressive disease
  • Surgical treatment (eg. grafting) may be used for adolescents with stable lesions that do not respond to traditional treatments.
  • Cosmetic camouflage (eg. Dermablend or Covermark) can be used to hide lesions of vitiligo
  • In patients with extensive vitiligo that have failed treatment, permanent depigmentation of normal skin may be considered.

PIGMENT MOSAICISM:

There is currently no treatment for this condition, although the condition may improve with time. Camouflage make-up may be recommended if the condition is cosmetically unacceptable to the patient.

The information above is also available for download in pdf format.

Common Pigmentation Problems in Children and Adolescents - Preparing for surgery

Common Pigmentation Problems in Children and Adolescents - Post-surgery care

Common Pigmentation Problems in Children and Adolescents - Other Information

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