|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 111-112
Universal acquired melanosis
Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
|Date of Web Publication||9-Apr-2015|
Department of Dermatology, Medical College and Hospital, 88, College Street, Kolkata 700 073, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Das A. Universal acquired melanosis. Indian J Paediatr Dermatol 2015;16:111-2
Universal acquired melanosis also termed as "carbon baby syndrome" is an uncommon phenomenon where pigmentation is usually present from early infancy but it may be progressive. It is often diffuse and generalized but may later become rather mottled.  The major determinant of normal skin color is the melanin, produced by melanocytes of the basal layer of the epidermis. Melanin production normally is not maximal in the newborn skin. Baby skin is slightly tanned for few days after birth, and it turns into racial color after few months due to repeated sun exposure. I have found a case, and as it is rare in its occurrence I am reporting it.
A 3-year-old boy born out of nonconsanguineous marriage presented with progressive generalized hyperpigmentation since 1-year of age. The darkening of the skin was first noticed over the face at the age of 1-year and gradually progressed cranio-caudally to involve the entire body. There was no history of prior drug intake or other skin lesions, no history of discoloration of urine or photosensitivity. On examination, baby had generalized dark-black hyperpigmentation, oral mucosa was involved; genitalia were spared. Face showed patchy areas of normal skin [Figure 1] and [Figure 2]. The skin texture and sweat secretion were normal. Systemic and ophthalmological examination was normal. Blood pressure was 106/74. Liver function tests, electrolytes, thyroid profile, serum cortisol, and ferritin were within normal limits. A diagnosis of universal acquired melanosis (carbon baby syndrome) was made.
|Figure 1: Hyperpigmented patches over forehead sparing the other areas of the face|
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There are multiple causes of diffuse hyperpigmentation of the skin in infancy. Classifications based on both clinical and histological findings increase the accuracy of diagnosis.
Kaviarasan et al. reported a similar case in a 3-year-old Indian girl who developed progressive diffuse hyperpigmentation by the age of 5 months. Histopathology revealed increased melanin deposition in epidermal basal layer. 
Furuya and Mishima reported a Japanese child with progressive pigmentary disorder. This child developed hyperpigmentation at the age of 3 months. At 4 years of age, the child was mentally retarded with partial hyperpigmentation of the body. Biopsy revealed hyperkeratosis, papillomatosis and proliferation of melanocytes. 
Addison disease (low blood pressure, hyponatremia, hyperkalemia, low serum cortisol level), Cushing disease (obese patient, cushingoid habitus, hyperglycemia, hypokalemia, elevated serum cortisol level), hemochromatosis (high transferrin saturation and ferritin level, genetic tests for the C282Y and H63D), and lichen planus pigmentosus (usually macular lesions, rarely diffuse hyperpigmentation, characteristic histopathology findings lichenoid infiltration, basal vacuolar change and prominent melanin incontinence; usually mild as compared to classical lichen planus).
Familial progressive hyperpigmentation (hyperpigmented patches at birth that gradually increased with age) were excluded based on their distinguishing features. 
Universal acquired melanosis is a diagnosis of exclusion. It is a progressive condition; long-term prognosis and treatment is not established. As "carbon baby syndrome" is a rare case, so it is worthy of reporting.
| References|| |
Anstey AV. Disorders of skin colour. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 8 th
ed. Oxford: Wiley-Blackwell ; 2010. p. 58, 22-3.
Kaviarasan PK, Prasad PV, Joe JM, Nandana N, Viswanathan P. Universal acquired melanosis (Carbon baby). Indian J Dermatol Venereol Leprol 2008;74:38-40.
Furuya T, Mishima Y. Progressive pigmentary disorder in Japanese child. Arch Dermatol 1962;86:412-8.
[Figure 1], [Figure 2]