Hyperpigmented macules on the face of young children: a series of 25 cases

Acquired hyperpigmented lesions in early childhood can be the presenting sign of serious diseases or benign conditions and often cause significant parental anxiety.

We sought to report a series of 25 young children with hyperpigmented macules on the forehead and temples without preceding erythema, edema, or desquamation.

We conducted a retrospective review of 25 children with similar clinical findings, seen from 2009 to 2013, from 5 medical centers in 3 countries.

There were 13 boys and 12 girls of many races. Their ages ranged from 2 to 24 months (mean 12.2 months, median 6 months). The hyperpigmentation presented abruptly in the summer (12 cases), spring (5 cases), winter (5), and fall (2), and was not clearly specified in 1 case. Histopathologic analysis in 3 cases was consistent with postinflammatory hyperpigmentation. After a follow-up period ranging from 3 months to 4.5 years, the lesions persist to a variable degree in 19 cases in which follow-up was possible.

The age of our patients precluded patch testing and/or invasive diagnostic methods.

The clinical features and prolonged clinical course over years do not correspond with any known or previously described cause of acquired facial hyperpigmented macules in young children.