Differential diagnosis of hypomelanoses in children

Differential diagnosis of hypomelanoses in children (N. Van Geel (Ghent, Belgium))

Use a stepwise approach

step 1 history

• congenital or acquired
• stable or progressive
• other medical problems
• family history

step 2 clinical examination

• localisation (Woods light important especially in the localized form)
• number of lesions
• pattern (linear blaschkoid, segmental)
• hypomelanosis or amelanosis
• other problems (neurological,  eyes)

step 3: Apply information of flowchart (differential diagnosis)

• if diffuse: presence or absence of ocular involvmenet

1. ocular involvement: albinos group, also Griscelli syndrome, Chediak-Higashi syndrome
2. no ocular involvement: think of Metabolic causes: Menkies syndrome, phenylcetonuria

• if localized

1. depigmentation: waardenburg, piedbaldism
2. hypopigmentation: tuberous scleroris, nevus depigmentosus, Pigmentation of inflammatory (PIH) or infectious origin, Pigmentary mosaicism (Hypomelanosis of Ito) lichen striatus
3. no pigment disorder: nevus anemicus

Source of Information: Sy 17. Pigmentation Disorders: From Vitiligo to Hyyperpigmentation. 2011 (10) – 20th Annual Congress of the EADV (European Academy of Dermatology and Venerology) – Lisbon (Lisboa), Portugal