Kids Pigmentation Disorders

Skin Pigmentation Disorders in Kids

Skin pigmentation disorders are a very common problem among children in Singapore and it can happen upon birth or develop soon after. Early intervention and treatment are often effective in managing and treating skin pigmentation disorders in children and teenagers.

What is a Skin Pigmentation Disorder?

Pigmentation means colouring. Skin pigmentation disorders occur when your child’s skin has either hyperpigmentation (too much pigment) or hypopigmentation (not enough pigment), or the body’s immune system has a reaction to pigment. This leads to white, red, or brown patches on the skin.

What causes Kids Pigmentation Disorders in Singapore?

Melanin is a pigment, which is where your skin gets its colouring from, made from cells in your child’s skin. Melanin overproduction occurs when these cells become damaged or are not healthy, leading to pigmentation issues.

Melasmas, cancers, skin injuries and trauma, certain drugs, and certain diseases may cause skin pigmentation disorders in children.

What are the different types of Pigmentation Disorders on Kids?

Excessive pigment is called hyperpigmentation (where the skin tone is darker than normal) and lack of pigment is called hypopigmentation (where the skin tone is lighter than normal skin colour).

There are many different types of skin pigmentation disorders in children. Common causes of hypopigmentation include post-inflammatory hypopigmentation, pityriasis alba, and vitiligo. While hyperpigmentation is commonly due to post-inflammatory hyperpigmentation, lentiginosis, and acanthosis nigricans.

Hypopigmentation

• Pigmentary mosaicism: appears as white patches on the skin very early on in life. It grows proportionally with the child and usually does not cause any complications. However, it can cause a lot of anxiety among parents. It is important to diagnose the condition and follow-up to ensure no other organs or systems are involved.
• Pityriasis alba: common cause of white patches on the face/body in young children. This usually happens due to dry skin, sun exposure, and eczema. Regular moisturisers and sunscreens will help to avoid this condition as recurrence is very high as well.
• Vitiligo: uncommon skin condition that is due to an immune reaction against the pigment cells in the skin. This condition causes a lot of anxiety among parents. It can occur at any age and presents as white to pink, flat, and well-demarcated patches on the skin. The hair within the white patches can also turn white. This condition can unfortunately progress to involve more areas of skin. Thus, it is very important to diagnose it and start treatment quickly. Despite treatment, if the condition progresses quickly, then it is imperative to start strong medications such as oral immunosuppressants, laser, or phototherapy. Children are more susceptible to sunburns, hearing loss, and skin cancer. Thus, preventive measures need to be taken.

Hyperpigmentation

• Post-inflammatory hyperpigmentation: common skin condition in children that develops after any skin injury due to trauma or a rash. The initial rash may be red, itchy, and swollen but as it resolves, it will leave a darker patch. This condition can self-resolve but may take up to many months to fade.
• Neuvs of Ota/Ito: bluish-brownish pigment that can occur on the face or upper body in children. Sometimes, it can be seen in babies as well. This condition tends to persist and grow proportionally with the child. An eye check is important especially if the condition extends to the conjunctiva (white portion of the eye).
• Acanthosis nigricans: thick velvety skin on the back of neck, groin, or armpits. It is common in adolescents and usually occurs in children with a family history of metabolic syndrome or obesity.

Which children are at risk of Skin Pigmentation Disorders in Singapore?

Children and adolescents with darker skin may be at risk for pityriasis alba. Spending too much time in the sun, having certain diseases, and taking certain drugs may also put you at risk for developing skin pigmentation disorders.

People with a family history of vitiligo, or have certain autoimmune diseases, including Addison's disease and pernicious anaemia, may be at risk of developing the skin pigmentation disorder.

How are Kids Skin Pigmentation Disorders diagnosed in Singapore?

Skin pigmentation disorders in children are often diagnosed through clinical examination. Skin biopsies and wood’s lamp examination may also be used to diagnose skin pigmentation disorders in children and adolescents.

What are the treatment options for Skin Pigmentation Disorders in Children?

The treatment options for skin pigmentation disorders in children vary greatly, as it depends on the severity and type of the condition. Here are the typical treatment options for some common skin pigmentation disorders in children:

Hypopigmentation

For hypopigmentation disorders such as pityriasis alba, vitiligo, and pigmentation mosaicism that cause white, or light patches on the skin, treatment usually includes:

• Frequent use of moisturisers
• Sun protection
• Topical anti-inflammatory creams
• Mild topical steroids or calcineurin inhibitors
• Prescription creams that contain hydroquinone and tretinoin
• Oral immunosuppressants
• Excimer laser treatment and/or narrowband phototherapy (for vitiligo)

Hyperpigmentation

For hyperpigmentation disorders such as post-inflammatory hyperpigmentation, nevus of ota/ito, and acanthosis nigricans that cause red, brown, or black patches on the skin, treatment may include:

• Sun protection
• Lightening creams
• Laser therapy
• Medicated soaps and creams
• Topical creams containing tretinoin and hydroquinone