 Occurs Following  Dermatitis  Acne  Infection  Injury  Description  Hyperpigmentation  Hypopigmentation  Course  Resolution over a few months  Genetic mosaicism  Born with 2 genetically different cell lines  Timing  May be seen at birth  May appear in infancy or early childhood  Description  Whorled, fountain-like pattern of alternating hypo- and hyperpigmentation  Blaschkoid distribution  Macules without vesicular or verrucous lesions  Other problems  CNS, MSK, eye  More likely if skin findings are prominent  Acquired partial to complete loss of pigmentation  Description  Well-demarcated hypopigmented and depigmented macules and patches  Enhance under Wood’s lamp  Absence of melanocytes  Location  Eyes, mouth, genitals, elbows, hands and feet  Can appear anywhere  Cause  Autoimmune  Timing  Congenital  Description  Well demarcated, hypopigmented macules  Lancinate shape  May enhance with Wood’s light  Location  Truncal  Associated with  Tuberous Sclerosis  Normal  0.5% newborns  Nevus depigmentosus  Localized form of pigmentary mosaicism  Timing  Congenital  Description  Hypopigmentation of the skin, eyes and hair  X-linked ocular  Skin is normal  AR  Oculocutaneous  Many variants  Complications  At risk of skin cancer  Must avoid excessive sun and use sunscreen  Variants  Tyrosinase-negative OCA  No trace of pigment  Snow-white hair, pinkish-white skin, translucent or blue irises  Also may have nystagmus, moderate to severe strabismus and poor visual acuity  Tyrosinase-positive OCA  Look similar at birth  Develop variable amounts of pigment with increasing age  Eye color – gray to light brown  Hair color – blonde or light brown  Partial albinism  AD – rare  Description  White forelock  Triangular patch of depigmentation and white hair on the frontal scalp  Circumscribed congenital leukoderma  Hypopigmented or depigmented macules on the face, neck, ventral trunk, flanks or extremities  May have scattered patches of normal pigmentation within  Variants  Waardenburg syndrome  Lateral displacement of the inner canthi and inferior lacrimal ducts  Flattened nasal bridge  Sensorineural deafness  Wolf syndrome  AR  Neurologic deficits  Description  Tan macules  May be a marker for  Neurofibromatosis type 1  Small and smooth borders  McCune-Albright  Large and segmental with jagged borders  Large or >4 An 8-year-old boy presents with a 2week history of an enlarging, tender lump on the scalp. The only notable finding on physical examination are alopecia overlying a boggy mass on the scalp and posterior cervical lymphadenopathy. Of the following, the MOST appropriate treatment is A. B. C. D. E. Cefazolin orally Griseofulvin orally Incision and drainage Ketoconazole topically Mupirocin topically  Alopecia Telogen Effluvium  Partial, temporary  3 months after an emotional or physical stress  <50% loss  Alopecia Anagen Effluvium  Sudden loss of growing hairs  80%  Tapering of the hair shaft and loss of adhesion to the follicle  Chemotherapy  Alopecia Areata  Description  Round or oval patches of hair loss  Absence of inflammation and scaling  Short (3-6mm) easily removable hairs at the margins  Location  Scalp, eyebrows, lashes or body  Severity  May be diffuse or generalized  Cause  Autoimmune  Other findings  Scotch-plaid pitting of the nails  Course  Difficult to predict  Treat any comorbid conditions  Trichorrhexis Nodosa  Timing  At any age  Description  Hair shaft breakage  Brittle, short hairs  Frayed edges by microscopy  Cause  Damage to the outer cortex of the hair shaft  Trauma, chemicals  Course  Resolution with removal of insult  Friction alopecia  Infants  Self-limited  Prevented/treated with tummy-time  If severe or long standing consider neglect  Traction alopecia  Maintaining a tight pull on the hair shafts  Ponytails, pigtails, braids, cornrows  Course  Shaft fractures and follicular damage  Can lead to permanent scarring  Trichotillosis  AKA trichotillomania  Timing  School-age children and adolescents  Description  Bizarre patterns of hair loss  Usually broad linear bands on vertex or sides of scalp  Side opposite of dominant hand  Short, broken-off hairs with stubs of different lengths  Never completely bald  Associations  Situational stress  Sometimes psychiatric  AR  Timing  Congenital  Etiology  Absence of or failure of formation of a localized area of scalp or skin  Dermis and epidermis  Some involve subq tissue and rarely calvarial defects  Location  Single lesion on vertex of scalp  Rarely multiple or involving trunk or extremities  Description  Birth  Sharply circumscribed open and weeping ulceration that may be covered by a thin membrane or crust  Healed in several weeks to months  Usually smooth atrophic scar  Look for hair collar sign  Neural tube defects  Associations  Limb defects, genetic anomalies  Treatment  Saline compresses  Topical antibiotics  Sterile dressings  Most common organism  Trichophyton tonsurans  Does not fluoresce  >95%  Microsporum canis  Fluoresces bluish-green  5%  Description is variable  Mild erythema and scaling with partial alopecia  Widespread breakage of the scalp  “salt-and-pepper”  More erythema, edema and pustules  Crusting  Heaped up scale with small pustules  Description is variable  Kerion  Intense inflammation with raised, tender, boggy plaques or masses studded with pustules  KOH mount shows infected hairs  Associated occipital, postauricular and posterior cervical adenopathy  Treatment  Oral antifungal agents  6 weeks to 4 months  Selenium sulfide shampoo  Steroids  Severe inflammation  Course  May lead to scarring and permanent hair loss if untreated  Prevention  Do not share!  Monilethrix  AD  Developmental hair defect  Timing  2-3 month of age  Description  Brittle, beaded hair  Periodic narrowing of the hair shaft  Location  Scalp most severely affected  Course  Permanent  Appearance may improve with age  Pili torti  Hair shaft is twisted on its own axis  Timing  Appears with first terminal hair growth of infancy  Location  Localized or generalized  Associations  Menkes kinky hair syndrome  Defect of copper absorption  CNS, CV, Skeletal systems  Paronychia  Acute  Red, swollen, tender nail fold  Bacterial invasion  Staph or strep  Chronic  One or several nails  Chronic dermatitis or frequent exposure to water  Nail dystrophy  Candida species  Treat with topical antimycotics  Onychomycosis  Fungal infection  Uncommon before puberty  Dystrophic nails  More commonly a result of trauma  Or underlying dermatosis  Subungual hemorrhage  Trauma  Crush injuries  Turf toe  Jamming toe into the end of a shoe suddenly  Description  Purplish-brown pigment  Treatment  Evacuation if painful