Pediatric Reports 2017; volume 9:7300

Congenital : A case observed in the cohort of HIV- Case Report Correspondence: Makoura Barro, Department of Pediatrics, Souro Sanou Teaching Hospital, 01 exposed infants in Bobo- Description BP 676, Bobo-Dioulasso 01, Burkina Faso. Dioulasso, Burkina Faso SM, a male infant, born on 27th E-mail: [email protected] September 2013, was received in the Paediatric Department in 2013 at the age of Key words: vitiligo, congenital, achromic Makoura Barro,1 Jean W. Diallo,2 2 months to be followed in connection with lesions. 1 Ad Bafa Ibrahim Ouattara, the prevention of mother-to-child transmis- 1 Boubacar Nacro sion (PMTCT). In fact he was born from Acknowledgements: this study hasn’t received funding from any sources, but technical support 1Department of Pediatrics, and HIV1 mother and father who were under was generously provided by Pediatric and 2 Department of Ophthalmology, Souro antiretroviral therapy (ART) since 2005. At Ophthalmology Departments at Bobo Dioulasso Sanou Teaching Hospital, Bobo- registration, SM was reported to have skin Teaching Hospital in Burkina Faso. Dioulasso, Burkina Faso and appendage lesions since his birth (Figure 1). Contributions: MB carried out the clinical evalu- On the skin we noted achromic plates ation and was the major contributor in writing with irregular contours but that could be the manuscript; JWD performed the ocular well seen with rounded zones normally pig- examination; ABIO carried out the clinical eval- Abstract mented in the centre and whose surface was uation; BN performed the skin examination. Vitiligo is a dermatological disease; its normal to the touch. No desquamation or sensitivity disorders were recorded. These Conflict of interest: the authors declare no poten- exact prevalence is unknown among the tial conflict of interest. paediatric population. We are reporting a anomalies were observed on: i) thoracic and abdominal levels where the plate was case of vitiligo at birth for the first time in Received for publication: 5 July 2017. Burkina Faso, in the Teaching Hospital roughly triangular, formed by the two nip- Revision received: 14 August 2017. Souro Sanou of Bobo-Dioulasso, Paediatric ples and the umbilicus measuring approxi- Acceptedonly for publication: 16 August 2017. Department. He is a male child, born from mately 10×15 cm; ii) the left knee and both HIV-1 positive parents; we received him arms; iii) an area from the left nostril to the This work is licensed under a Creative Commons Attribution NonCommercial 4.0 when he was 2 months to be followed in upper half-nostril; iv) concerning the License (CC BY-NC 4.0). connection with the prevention of mother- appendages, there was a depigmented front lock of hair and the surface was aboutuse 2 to-child transmission. He showed achromic ©Copyright M. Barro et al., 2017 cm2. lesions on the skin and on skin appendages Licensee PAGEPress, Italy at birth. In addition to congenital vitiligo we Ophthalmological examination noted Pediatric Reports 2017; 9:7300 mentioned, several diagnostic hypotheses macroscopically: i) partial achromia on the doi:10.4081/pr.2017.7300 were discussed. No treatment was decided left eyebrow; ii) the cornea was clear, an to face these skin lesions given the very anterior chamber deep and free of cells, a young age of the patient. Psychological sup- diffuse iris achromia leading to a white iris. The lens was transparent and the ocular Evolution port is planned in the long run. pressure was normal in both eyes. When he was 2 years old we noted the The fundus examination revealed a dif- same skin and eye lesions. Blood sugar was fuse atrophy of the retinal epithelium pig- normal; rapid HIV test was negative. ment while the optic disc had a normal Introduction The child left the cohort of HIV- aspect.commercial exposed infants but was quarterly moni- Vitiligo is an acquired A biochemical profile was conducted tored in the department for vitiligo. disease that affects 1-2% of the general pop- and showed normal blood sugar. HIV-PCR Monitoring in the eye clinic was set once ulation without any racial, sexual, or made during the registration has become quarterly. regional predominance.1 The exactNon preva- negative. SM received no treatment for his lence in the paediatric population is skin and appendage lesions. unknown.2 In almost half of the patients, it starts before 18 years of age and congenital Antecedents Discussion forms are uncommon.3 Although aetiology SM was born from a term pregnancy by of the disease is unknown, there are several caesarean section due to foetal distress and Vitiligo at birth is a very rare phe- 4 theories including autoimmune and neuro- he was hospitalized within few hours after nomenon. Only Chandra, Kambhampati, logic mechanisms, genetic factors, the role his birth in the neonatal department because Lerner and Nordlund had earlier reported of oxidative stress or toxic metabolites and of mother-foetus infection with concept of such a case in their series.4-6 The hypome- lack of growth factor.3 There brain distress but the germ has not been lanotic with poorly defined borders type are a few studies that assess congenital identified. He was declared cured after 14 could be a good indicator of the actual forms.4 However, the existence of these days. His relatives denied any personal or activity of a vitiligo lesion.7 In according to congenital forms is still controversial.2 We family history of . Kambhampati,5 considering the site, center, are reporting in this study a case of vitiligo The diagnosis was: congenital vitiligo. and progression of the lesion, in the absence at birth from Burkina Faso in the Paediatric This was clinically made basing on the of a white forelock and poliosis, the diagno- Department of Souro Sanou Teaching classic cutaneous and appendage lesions. sis of congenital vitiligo was favored in his Hospital, in Bobo-Dioulasso. The case will No additional examination such as skin study. To the best of our information this is be presented with regard to the differential biopsy was performed to make this diagno- the first case of congenital vitiligo reported diagnosis. sis. from Burkina Faso.

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Achromic lesions observed at birth, in plete leukoderma or hypopigmented mac- involved and justify a structured diagnostic addition to congenital vitiligo, as well as ules on the entire skin, hair and eyes.10 approach. Psychological support is very other diagnostic hypotheses such as vitiligo We opted for not treating our patient important to this patient because of the dis- leprosy, achromic Ito disease given his young age but especially because figurement that people often experience (Hypomelanosis of Ito), oculocutaneous of harmful consequences that therapies because of the social impact. (OCA), , tuberous scle- might have on his health. In general, treat- rosis complex, and depigmentosus ment for many hypopigmented disorders is could be mentioned. In fact, vitiligo leprosy limited, especially those which have a con- is a diagnosis that we should sometimes genital origin.9 The primary outcome of References refer to before an achromic lesion. Hypo- various existing methods is recoloring melanistic blotches, often scaly, are the seat depigmentation plates either by stimulating 1. Esfandiarpour I, Farajzadeh S. Clinical of sensory disturbances (anaesthesia or the proliferation of still present characteristics of late-onset vitiligo in hypoesthesia),8 which is not the case of our (phototherapy, topical treatments such as an Iranian population. Dermatol Sin patient. The lesions in hypomelanosis of Ito corticoid therapies) or by performing a 2012;30:43-6. tends to follow the contours of Blaschko.9 melanocyte transplant. In a systematic 2.Ammour A, Jouary T, Taieb A, Piebaldism is an uncommon autosomal review, the most commonly used drugs Mazereeuw-Hautier J. Le vitiligo de dominantly inherited congenital pigment were tacrolimus alone (or combined with l’enfant. Ann Dermatol Vénér anomaly with a white forelock and leuko- clobetasol), pimecrolimus, corticosteroids, 2010;137:654-8. derma on the frontal scalp, forehead, ventral and calcipotriol.11 All these methods may 3.Farajzadeh S, Aflatoonian M, trunk and extremities.10 Tuberous sclerosis have consequences in the short, medium or Mohammadi S, et al. Epidemiological (tuberous sclerosus) is an autosomal domi- long run on the health of the patient. In aspects and disease association of child- nant disease characterized by skin manifes- addition to the fact that no therapy is hood vitiligo. J Pak Assoc Dermatol tations (hypo-melanistic or achromic planned, we have envisaged psychotherapy 2016;25:105-10. blotches on the skin, visible from child- when the child will become aware of his 4. Chandra S, Kumar A, Singh K, Mohan hood; angiofibromas of the face; grief skin unsightly lesions. L. Congenital vitiligo. Indian J appearance on the bottom of the back; onlyDermatol Venereol Leprol 1992;58:339. Koenen tumours of the nails), as well as 5. Kambhampati BNS, Sawatkar GU, heart, brain and kidney manifestations. Kumaran MS, Parsad D. Congenital Nevus depigmentosus is a congenital Conclusions vitiligo: a case report. J Cutan Med Surg demarcated hypopigmented blotch with a use 2016;20:354-5. serrated and irregular border. It is common- Vitiligo at birth is very rare. We have 6. Lerner AB, Nordlund JJ. Vitiligo: What ly present at birth and changes a bit there- been able to make its clinical diagnosis is it? Is it important? JAMA after. includes thanks to the classic lesions of our patient. 1978;239:1183-7. inherited disorders characterized by com- However, many other conditions can be 7. Benzekri L, Gauthier Y. Clinical mark- ers of vitiligo activity. J Am Acad Dermatol 2017;76:856-62. 8. Devillers C, Szepetiuk G, Pierard C, Pierard G. Comment j’explore... une dermatose hypochromique ou achro- mique. Rev Med Liège 2010;65:109- 12. commercial 9. Tey HL. A practical classification of childhood hypopigmentation disorders. Acta Derm-Venereol 2010;90:6-11. 10. Oiso N, Fukai K, Kawada A, Suzuki T. Piebaldism. J Dermatol 2013;40:330-5. Non 11. Menezes AF, Oliveira de Carvalho F, Barreto RS, et al. Pharmacologic treat- ment of vitiligo in children and adoles- cents: a systematic review. Pediatr Figure 1. Clinical figures of a 2-month-old boy with congenital vitiligo. Dermatol 2017;34:13-24.

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