Photoclinic: Postinflammatory Hypopigmentation

Two infants with a history of dermatitis were noted to have postinflammatory hypopigmentation. Figure A shows hypopigmentation in a 6-month-old infant that appeared after resolution, 1 month earlier, of a nonspecific perioral dermatitis associated with excessive drooling. Figure B shows the hypopigmentation in a 5-month-old infant that developed after 4 months of persistent inflammation, erythema, and irritation in the diaper area and upper medial thighs. The chronicity and severity of the rash was the likely cause of the hypopigmentation, a complication not seen with the usual diaper rash. Robert P. Blereau, MD, of Morgan City, La, writes that the cause of hypopigmentation is usually evident in individual cases. Primary forms of hypopigmentation are albinism and vitiligo. Skin diseases that cause acquired hypopigmentation include tinea versicolor, chronic discoid lupus erythematosus, localized scleroderma, psoriasis, secondary syphilis, pinta, and chronic inflammatory dermatitides. Acquired hypopigmentation may also be caused by chemicals, including mercury compounds, monobenzyl ether of hydroquinone, and cortisone-type drugs given intralesionally.1 Postinflammatory hypopigmentation eventually resolves. Treatment usually does not provide additional benefit, except when residual inflammation remains, as in some cases of pityriasis alba. In this setting, a lowpotency topical corticosteroid may prevent further pigment loss.2 The 5-month-old’s diaper rash was treated with cornstarch and nystatin-triamcinolone cream and, most important, immediate changing of wet diapers along with air exposure as much as possible for drying.