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hyperpigmentation

Connecting the Spots: Hyperpigmented Lesions in Children

Teaser: 

Lisa M. Flegel,1 Joseph M. Lam, MD, FRCSC,2

1Medical Degree Undergraduate Program, Northern Medical Program, University of British Columbia, BC.
2Clinical Assistant Professor, Department of Pediatrics and Dermatology, University of British Columbia, BC.

CLINICAL TOOLS

Abstract: Hyperpigmented lesions are common in the pediatric population and identifying their etiologies can be challenging for physicians. Patients and caregivers may worry that hyperpigmented lesions are dangerous, associated with an internal illness or that they may lead to skin cancers. Having a better understanding of the causes and natural histories of these lesions may help to guide management and alleviate worry. This review article will provide an overview of select common and uncommon causes of hyperpigmented skin lesions in children.
Key Words: hyperpigmentation, pediatric.
1. Most hyperpigmented lesions in children do not require treatment aside from for cosmesis.
2. Features of malignant melanoma in children include: non-pigmented, uniform color, variable diameter, nodular lesions, and occurring de novo.
3. Parents and children should be warned that melanocytic nevi will grow as their child grows, but growth should be proportionate.
4. The risk of melanocytic nevi becoming malignant melanoma in children is very small.
In children with numerous melanocytic nevi, a good rule of thumb is to look for the 'ugly duckling' mole.
To track lesions over time, parents can develop a routine of taking a picture each year on the child's birthday.
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A Reticulate Hyperpigmented Abdominal Patch Associated with Chronic Abdominal Pain

A Reticulate Hyperpigmented Abdominal Patch Associated with Chronic Abdominal Pain

Teaser: 

Julie Man, MD,1 Joseph M. Lam, MD, FRCPC,2

1Department of Family Medicine, University of Alberta, Edmonton, AB.
2Assistant Clinical Professor, Department of Paediatrics, Associate Member, Department of Dermatology, University of British Columbia, BC.

CLINICAL TOOLS

Abstract: A 13-year-old girl presented with a 3-month history of a reticulate hyperpigmented patch over the lower abdomen. Her past medical history was significant for recurrent abdominal pain, Ehlers-Danlos syndrome, a mild learning disability, and multiple allergies. On physical examination, she had a reticulate, hyperpigmented patch distributed diffusely over the lower abdomen (Figure 1). The remainder of her exam was unremarkable. Upon questioning, it was revealed that the patient had been applying a hot water bottle to the lower abdomen for the last 4 months to help relieve the discomfort associated with the abdominal pain. This history led to the diagnosis.
Key Words: Erythema ab igne, hyperpigmentation, reticulate, thermal injury.
Erythema ab igne may present as a transient erythematous eruption, or as a reticulate hyperpigmentation.
Erythema ab igne is a clinical diagnosis which rarely requires biopsy confirmation.
Direct questioning about heat sources, such as prolonged laptop computer use, aids the diagnosis.
Treatment consists of patient education and removal of the heat source.
1. Erythema ab igne is a recognizable condition associated with chronic exposure to heat sources such as heating pads, hot water bottles, electric blankets, space heaters and laptop computers.
2. The differential diagnosis for erythema ab igne includes livedo reticularis, livedoid vasculitis, cutis marmorata telangiectatica congenita, a reticulate port-wine stain and poikiloderma.
3. The most important treatment for erythema ab igne is recognition and removal of the source of infrared radiation.
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