Chapter 15: Pediatric Dermatology

DISORDERS OF PIGMENTATION

Mongolian Spot

• Presentation (Fig. 15-1)

  • Blue-gray patches present at birth or early infancy

  • Usually buttocks, lumbosacral back

  • Common in black, Hispanic, and Asian races

  • Color due to Tyndall effect (scattering of light as it strikes dermal melanin)

• Course

  • Usually resolves by early to late childhood

  • Extensive Mongolian spots (dermal melanocytosis) with dorsal/ventral distribution, indistinct borders, and persistent and/or “progressive” behavior may be a sign of underlying lysosomal storage disease (most commonly GM1 gangliosidosis type 1 and Hurler disease)

Nevus of Ota

• Also known as oculodermal melanocytosis, nevus fuscoceruleus ophthalmomaxillaris (Fig. 15-2)

• Presentation

  • Unilateral bluish gray discoloration of facial skin and adjacent cornea; in darker skin blue component is less obvious

  • Affects region supplied by trigeminal nerve V₁ and V₂ ± ipsilateral sclera

  • Congenital or acquired by second decade

  • More common in black or Asian races, females

• Treatment: pigmented lesion lasers

• Course

  • Persists; both this and nevus of Ito may increase in size/intensity over time

  • Ocular involvement: risk of glaucoma, small melanoma risk

Nevus of Ito

• Also known as nevus fusoceruleus acromiodeltoides (Fig. 15-3)

• Presentation: similar to nevus of Ota but localized to unilateral shoulder, lateral neck, scapula, and/or deltoid

• Course: persists

• Treatment: pigmented lesion lasers

Mosaic Hypopigmentation

• Includes hypomelanosis of Ito (incontinentia pigmenti acromians), nevus depigmentosus (achromic nevus) (Fig. 15-4)

• Presentation

  • Benign, hypopigmented oval or round patches, bands, or swirls

  • May be localized or extensive

  • Arranged along one or more Blaschko lines

  • No preceding vesicular or inflammatory stages

  • Incidence of systemic manifestations highest with most extensive lesions

  • Most commonly central nervous system (CNS), musculoskeletal, and eyes depending on particular chromosome defect and level of mosaicism

• Course: persists

VASCULAR DISORDERS

Blueberry Muffin Baby

• Presentation (Fig. 15-5)

  • Multiple, dark blue to magenta, small, nonblanching papules and macules

  • Present at birth or by first day of life

• Etiology

  • Extramedullary hematopoiesis

  • Associated with congenital infections (TORCH viruses, most commonly cytomegalovirus), hemolytic disease of the newborn, hereditary spherocytosis, twin-twin transfusion syndrome

• Differential

  • Includes neoplastic-infiltrative disease (lesions typically ...