Hot Topics in Pediatric Dermatology

Lian Sorhaindo; Anthony Rossi; Andrew Alexis; Nanette B Silverberg

Disclosures

Expert Rev Dermatol. 2010;5(3):259-267. 

In This Article

Specific Issues in Children of Color

The session 'Specific issues in children of color' was presented by Andrew Alexis from the St Luke's Roosevelt and Beth Israel Medical Centers (NY, USA). There are a number of dermatologic concerns in children of color, including pityriasis rosea, tinea capitis, postinflammatory pigmentation alteration, pityriasis alba and vitiligo.

Prospective observational studies have revealed that children of color have more frequent facial involvement associated with pityriasis rosea. Once the lesions resolve, most of these children have residual postinflammatory pigmentary alteration.[9] Postinflammatory hyperpigmentation may be secondary to inflammatory mediators, including prostaglandins and leukotrienes that are responsible for epidermal stimulation of melanocytes. Disruption of the basal layer leads to deposition of melanin and engulfment by macrophages. Although there are a number of treatment options for postinflammatory hyperpigmentation, including hydroquinone, azeleic acid, chemical peels, retinoids and cover-up cosmetics, there are currently no studies in the pediatric population. In addition to hyperpigmentation, postinflammatory hypopigmentation is also a major concern in children of color.

Tinea capitis is most commonly seen in black children aged 3–7 years old, with Trichophyton tonsurans being the leading dermatophyte isolated within the USA. Treatment may include the following regimens: griseofulvin (microsized suspension 25 mg/kg) for 6–8 weeks until clinical and mycological cure; and the recently US FDA-approved terbinafine (125 mg/day) for patients that are 25 kg in weight, versus terbinafine (187.5 mg/day) for patients who are 25–35 kg in weight. The maximum dose of terbinafine is 250 mg per day. Other alternative therapies include off-label use of itraconazole and fluconazole.[10]

Pityriasis alba is seen in up to a third of school-age children, leaving patients with hypopigmented areas that slowly repigment. Most cases resolve over several months to 1 year. Treatment options include: topical corticosteroids, pimecrolimus[11] and tacrolimus.[12]

Vitiligo affects approximately 1% of the population and is prevalent in the pediatric population, with half of all cases occurring before the age of 20 years. Vitiligo is secondary to a complex interplay of genetic, immunological and environmental factors. In the pediatric population, approximately 20% of cases are segmental in nature (vs 5% in the adult population). In addition, vitiligo is primarily associated with autoimmune thyroiditis, whereas adult vitiligo has been associated with multiple autoimmune diseases including alopecia areata, diabetes mellitus, pernicious anemia, Hasihmoto's thyroiditis and Addison's disease. Chomosome 17p13 (the NALP1 gene) has been implicated in the susceptibility to multiple autoimmune diseases.[13] In pediatric patients with vitiligo, there is a strong association with a family history of vitiligo, as well as a strong predilection for vitiligo in females.[14] There are number of treatment options for vitiligo in the pediatric population, including topical calcineurin inhibitors, calcipotreine, narrow-band UVB, excimer laser, minigrafting, micropigmentation and suction blister transplantation.

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