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ORIGINAL ARTICLE
Year : 2017  |  Volume : 18  |  Issue : 1  |  Page : 9-13

A clinico-epidemiological study of hypopigmented and depigmented lesions in children and adolescent age group in Hadoti region (South East Rajasthan)


1 Department of Skin and VD, Government Medical College, Kota, Rajasthan, India
2 Department of Skin and VD, Mysore Medical College Research Institute, Mysore, Karnataka, India

Date of Web Publication12-Dec-2016

Correspondence Address:
K R Raghavendra
Department of Skin and V D, Mysore Medical College Research Institute, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.188463

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  Abstract 


Background: Hypopigmentory and depigmented lesions are common among children and adolescent group. The parents are very much concerned about the condition and they seek dermatologist advice without fail.
Aims and Objectives: To evaluate the Epidemiology and clinical characteristics of Hypopigmented and Depigmented Lesion in patients of Children and Adolescent age group in Hadoti region in Rajasthan.
Materials and Methods: The study was conducted for the period one year from April 2015 to March 2016. This planned study is to be undertaken in children age 0-19 yr with hypopigmented and depigmented lesions irrespective of sex.
Results: The most common disorder was Pityriasis alba, seen in 27.33%, followed by Pityriasis versicolor in 21%, Vitiligo 19.33%, Post inflammatory hypopigmentation in 14%, Primary disorders of hypopigmentation in 13%, Hansen's disease in 1.33%, and miscellaneous conditions in 4% of the cases.
Conclusion: The most common hypopigmentary disorders are seen in our study is Pityriasis alba and other causes of hypopigmentary and depigmentory disorders are in decreasing order are Pityriasis versicolor, Vitiligo, Postinflammatory hypopigmentation, Primary causes of hypopigmentation and less common are Leprosy.

Keywords: Depigmentary lesion, Hadoti region, hypopigmentary lesion, pityriasis alba, pityriasis versicolor


How to cite this article:
Soni B, Raghavendra K R, Yadav DK, Kumawat P, Singhal A. A clinico-epidemiological study of hypopigmented and depigmented lesions in children and adolescent age group in Hadoti region (South East Rajasthan). Indian J Paediatr Dermatol 2017;18:9-13

How to cite this URL:
Soni B, Raghavendra K R, Yadav DK, Kumawat P, Singhal A. A clinico-epidemiological study of hypopigmented and depigmented lesions in children and adolescent age group in Hadoti region (South East Rajasthan). Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Aug 22];18:9-13. Available from: http://www.ijpd.in/text.asp?2017/18/1/9/188463




  Introduction Top


Pigmentary disorders are nowadays most common group of dermatoses in neonate, children, and adolescent age group.[1] Pigmentary disorders in children are somewhat different from those in the adults in terms of etiology, and also there will be more of heightened parental concerns.[2] Among pigmentary disorders, hypopigmented lesions in children are very common occurrence. Hypopigmentation and depigmentation have been referenced in many ancient religious texts as a curse or contagious disease. Hypopigmentation refers to any form of decreased pigmentation whereas, depigmentation, in contrast to hypopigmentation, describes the almost total loss of pigmentation, resulting in a whitish appearance that comes from the underlying dermis.[3] Hypopigmentary cutaneous disorders can be a consequence of different disturbances in the pigmentary system that include defects in the number or function of melanocytes, decreased melanization of melanosomes or decrease of the transfer process from melanocytes to keratinocytes.[4] Loss of pigment can have a profound psychological impact on the parents of the affected child. Hypopigmented lesions in children can be as benign as pityriasis alba, pityriasis versicolor and as severe as Indeterminate leprosy.[3] The other causes are nevus anemicus, postinflammatory depigmentation, polymorphic light eruption, Hypomelanosis of Ito, nevus depigmentosus. Causes of depigmentation include vitiligo and piebaldism. The purpose of this study is to evaluate the various causes of hypopigmented and depigmented lesions in patients of children and adolescent age group in Hadoti region (South East Rajasthan).


  Materials and Methods Top


The study was conducted on patients attending the outpatient department of Department of Dermatology, Venereology, and Leprology of Government Medical College and attached group of Hospital, Kota, Rajasthan for the period 1 year from April 2015 to March 2016. Institutional Ethic Committee approval was taken. This planned study is to be undertaken in children age 0–19 years with hypopigmented and depigmented lesions irrespective of sex. All children age 0–19 years with hypopigmented and depigmented lesions attending the skin out-patient department, and those who gave valid informed consent from the guardian were included in the study. The Patients whose age more than 19 years and patients whose parents have not given consent for the study were excluded. Patients will be examined by an investigator for the diagnosis of hypopigmented and depigmented lesions. Informed consent of the parents or the guardian will be taken. Data will be recorded including patient name, age, sex, onset, characteristic of lesion, presence of any skin diseases, prolonged illness, family history, etc., according to predesigned pro forma. Photographs were taken for documentation after taking consent from guardian. The following investigations were done depending on the clinical presentation-skin biopsy was done in suspected cases of Hansen's disease, vitiligo, nevus depigmentosus, etc., Woods lamp examination was done in suspected cases of vitiligo, nevus depigmentosus, pityriasis versicolor. KOH mount to identify any fungal etiology. Complete hemogram to rule out any nutritional deficiencies and hematological abnormalities. Slit skin smear-In suspected cases of Hansen's disease. Data were analyzed using descriptive statistical analysis.


  Results Top


A total number of 300 patients of hypopigmentated and depigmented age group 0–19 years for the study. Among them, 146 (48.66%) were female children and 154 (51.33%) were males children. The majority of children belonged to the age group 0–6 years (41%) and the mean age of onset was 7.96 ± 5.24 years. At birth, only 11% of children had symptoms. The most common disorder was pityriasis alba [Figure 1], seen in 27.33%, followed by pityriasis versicolor in 21% [Figure 2], vitiligo 19.33% [Figure 3], postinflammatory hypopigmentation in 14%, primary disorders of hypopigmentation in 13%, Hansen's disease in 1.33% [Figure 4], and miscellaneous conditions in 4% of the cases [Table 1]. The face was most common site to involve in 50.3% children. Out of 82 cases of pityriasis alba, 48 cases (58.36%) had a history of atopy and anemia was seen in 18 cases (21.95%). Among vitiligo patients 13 were suffering from anemia and hypothyroidism was seen in 2 cases. The most common primary disorder of hypopigmentation was 15 cases (38.46%) nevus depigmentosus followed by 7 cases (17.94%) nevus anemicus, 5 cases (12.82%) each of tuberous sclerosis complex and Halo nevus, 3 cases (7.69%) of piebaldism, 2 cases (5.12%) of Hypomelanosis of Ito and 1 case (2.56%) each of Waardenburg syndrome type-1 and generalized idiopathic guttate hypomelanosis [Table 2]. Among cases of Hansen's disease three cases were in borderline tuberculoid (BT) type and two cases were in tuberculoid type Hansen's disease.
Figure 1: Multiple hypopigmented patches over face clinically suggestive of pityriasis alba

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Figure 2: Multiple hypopigmented macules coalescing to form large patches suggestive of pityriaisis versicolor

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Figure 3: depigmented patches with island of pigmentation over extensor aspect suggestive of vitiligo vulgaris

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Figure 4: Multiple hypopigmented and hypoanesthetic patches almost all over the body suggestive of Hansens disease

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Table 1: Distribution of hypopigmented and depigmented lesions

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Table 2: Pigmentory disorders

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  Discussion Top


In this study, the majority of children belonged to the age group of 0–6 years (41%) and other were 7–12 years (35.67%). Onset at birth presents in 11% of children. The mean duration was 1.12 years. According to Sori et al.,[2] the most common age group was 6–10 years contributing to 30.0% children, followed by 11–14 years contributing to 28.1%. Nine percent of children had onset at birth, and the mean duration of the disorders was 1.64 years which is in accordance to this study results. We observed that most common hypopigmentary disorders were pityriasis alba, pityriasis versicolor, vitiligo, postinflammatory hypopigmentation, primary disorder of hypopigmention, and leprosy in decreasing order. According to Pinto and Bolognia,[4] the most common disorders of hypopigmentation in children were pityriasis alba, vitiligo, nevus depigmentosus, and tinea versicolor in accordance with our results. The face was the most commonly affected site seen in 50.33%, followed by back in 30%, chest in 18.33%, legs in 14.33%, hands in 10.33%, abdomen in 6.66%, whole body in 3.33%, and genitalia in 0.66% and above observations were in accordance with Sori et al.[2] Out of 82 cases of pityriasis alba, majority of the children (98.78%) were below 15 years. Children with a history of atopy seen in 58.53%. Anemia was seen in 21.95% of children. Pityriasis alba had duration <6 months was seen in 89.02% children. Vinod et al.,[5] in their study of 200 cases of pityriasis alba, found 69% of their cases below 15 years of age. Personal history of atopy was noted in 17% patients. Anemia was seen in 15.5% of cases. The majority (84.5%) of patients had lesions of <6 months duration at the time of presentation. Pityriasis alba is found almost entirely in preadolescent children. They usually present as well-defined or ill-defined, hypopigmented macules with fine superficial scaling. In this study, 82.5% of cases were in the age group 10–19 years, 9.52% of cases were seen in infants. Back and chest was the most common site affected in 85.71% cases followed by face seen in 15.87% cases. Ghosh et al.,[6] conducted a study a clinicomycological and epidemiological study on pityriasis versicolor in Kolkata and found almost similar to the above observation. Most of the lesions were hypopigmented scaly macules and most commonly involved sites were chest, face, and back. Jena et al.'s [7] study of pityriasis versicolor in 271 children, majority of children were aged 8–12 years (31.7%), but 10 infants were also affected. Face was the most affected site (39%), and extensive involvement was seen in 16.6% children with lesions on the back and shoulder. In this study, the most common type seen was Vitiligo vulgaris in 51.72%, followed by acrofacial vitiligo in 18.96%, focal vitiligo in 13.79%, segmental vitiligo in 10.34%, and mucosal vitiligo in 5.17%. The face was most common site affected in 46.55% children. Family history was seen in 8.62% cases of vitiligo. Jain et al.,[8] in a study conducted on 35 vitiligo patients, observed that most common site of onset of vitiligo was face (25.71%) followed by lower limb (20%). The most common pattern observed in childhood vitiligo was vitiligo vulgaris (48.5%), followed by focal vitiligo (25.7%). Other less common pattern were segmental (11.42%), mucosal (5.7%), mixed (2.8%), contact (2.8%), and acrofacial (2.8%). Jaisankar et al.[9] reported that vitiligo vulgaris was the commonest type followed by segmental, focal, acrofacial, and mucosal vitiligo. In this study, the most common association with vitiligo was anemia seen in 13 cases (22.41%), followed by 2 cases of (3.44%) hypothyroidism. Handa and Dogra [10] have reported an autoimmune association in 1.3% of children with vitiligo. Mazereeuw-Hautier et al.[11] have reported the association of thyroid function abnormalities without clinical disease in 11.23% of children with nonsegmental vitiligo but none in segmental vitiligo. In this study, the most common type of Hansen's disease was BT type leprosy in 75%, followed by 25% of tuberculoid type leprosy. Ulnar neuritis was seen in one child. History of contact with lepromatous leprosy patients (mother) was present in this child with BT leprosy. Histopathological features were consistent with the clinical diagnosis in all cases. According to Singal et al.,[12] BT leprosy was the most common type, encountered in 70·3% patients which is in accordance to this study results. Kumar et al.[13] in their study, recorded the most common type was BT leprosy (78.7%) followed by borderline lepromatous leprosy (8.2%), indeterminate leprosy (6.6%), lepromatous leprosy (4.9%), and pure neuritic leprosy (1.6%). Swain et al.[14] noted that 57% cases of leprosy in children occurred from household contact with their father having lepromatous leprosy.


  Conclusion Top


The study concludes by stating that the most common hypopigmentary disorders are seen is pityriasis alba and other causes of hypopigmentary and depigmentory disorders in decreasing order are pityriasis versicolor, vitiligo, postinflammatory hypopigmentation, primary causes of hypopigmentation, and less common are leprosy. The most common primary disorders of hypopigmentation are nevus depigmentosus, nevus anemicus, Halo nevus, Tuberous sclerosis complex, piebaldism, Hypomelanosis of Ito in the decreasing order of frequency.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Toossi P, Nabai L, Alaee Z, Ahmadi H, Saatee S. Prevalence of skin diseases and cutaneous manifestations among Iranian children: A survey of 1417 children. Arch Dermatol 2007;143:115-6.  Back to cited text no. 1
    
2.
Sori T, Nath AK, Thappa DM, Jaisankar TJ. Hypopigmentary disorders in children in South India. Indian J Dermatol 2011;56:546-9.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Tey HL. A practical classification of childhood hypopigmentation disorders. Acta Derm Venereol 2010;90:6-11.  Back to cited text no. 3
    
4.
Pinto FJ, Bolognia JL. Disorders of hypopigmentation in children. Pediatr Clin North Am 1991;38:991-1017.  Back to cited text no. 4
    
5.
Vinod S, Singh G, Dash K, Grover S. Clinico epidemiological study of pityriasis alba. Indian J Dermatol Venereol Leprol 2002;68:338-40.  Back to cited text no. 5
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Ghosh SK, Dey SK, Saha I, Barbhuiya JN, Ghosh A, Roy AK. Pityriasis versicolor: A clinicomycological and epidemiological study from a tertiary care hospital. Indian J Dermatol 2008;53:182-5.  Back to cited text no. 6
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Jena DK, Sengupta S, Dwari BC, Ram MK. Pityriasis versicolor in the pediatric age group. Indian J Dermatol Venereol Leprol 2005;71:259-61.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
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Jain M, Jain S, Kumar R, Mehta P, Banjara N, Kalwaniya S. Clinical profile of childhood vitiligo patients in Hadoti region in Rajasthan. Indian J Paediatr Dermatol 2014;15:20-3.  Back to cited text no. 8
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Jaisankar TJ, Baruah MC, Garg BR. Vitiligo in children. Int J Dermatol 1992;31:621-3.  Back to cited text no. 9
    
10.
Handa S, Dogra S. Epidemiology of childhood vitiligo: A study of 625 patients from North India. Pediatr Dermatol 2003;20:207-10.  Back to cited text no. 10
    
11.
Mazereeuw-Hautier J, Bezio S, Mahe E, Bodemer C, Eschard C, Viseux V, et al. Segmental and nonsegmental childhood vitiligo has distinct clinical characteristics: A prospective observational study. J Am Acad Dermatol 2010;62:945-9.  Back to cited text no. 11
    
12.
Singal A, Sonthalia S, Pandhi D. Childhood leprosy in a tertiary-care hospital in Delhi, India: A reappraisal in the post-elimination era. Lepr Rev 2011;82:259-69.  Back to cited text no. 12
    
13.
Kumar B, Rani R, Kaur I. Childhood leprosy in Chandigarh; clinico-histopathological correlation. Int J Lepr Other Mycobact Dis 2000;68:330-1.  Back to cited text no. 13
    
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Swain JP, Mishra S, Jena S. Prevalence of leprosy among household contacts of leprosy cases in western Orissa. Indian J Lepr 2004;76:19-29.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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