Eruptive hypomelanosis, Paraviral exanthem, Children
Eruptive hypomelanosis is a recently described paraviral exanthem, probably related to viral infections. Most patients are young children aged between 02 and 10, and develop flu-like prodromal symptoms.
We report the case of a 07-year-old child, with no notable history, who consulted for an acute cutaneous eruption made up of hypochromic, non-pruritic macules, which began 10 days ago, preceded by a transient flu-like syndrome 08 days before its onset. The rash began on the arms and spread to the rest of the integument within a few days. Clinical examination revealed well-limited macular lesions, 0.1 to 0.5 cm in size, covered with pityriasiform scales, confluent in places, symmetrical, involving the face, neck, trunk and limbs, with a predominance on the roots of the upper limbs and shoulders (Figure 1). The pharyngeal mucosa was slightly congested, and the rest of the somatic examination and standard laboratory tests were normal. Diagnoses included pityriasis versicolor, pityriasis alba, progressive macular hypomelanosis and post-inflammatory hypopigmentation. Skin biopsy revealed mild orthohyperkeratosis, mild epidermal spongiosis and non-specific inflammatory lymphocytic infiltrates in the upper dermis. Mycological examination of the scales was negative, and the absence of previous inflammation ruled out the possibility of post-inflammatory hypopigmentation. The child was put on emollient cream, and the lesions began to disappear around the third week of treatment. Given this short duration of evolution, the diagnosis of progressive macular hypopigmentation was also unlikely, and the diagnosis of eruptive hypomelanosis was retained.
Figure 1: Symmetrical macular lesions covered with pityriasiform scales on the face, neck, trunk and limbs.