title: Hyperpigmented macules on the face of young children: a series of 25 cases.
abstract: BACKGROUND
  Acquired hyperpigmented lesions in early childhood can be the presenting sign of serious diseases or benign conditions and often cause significant parental anxiety.
  
  
  OBJECTIVE
  We sought to report a series of 25 young children with hyperpigmented macules on the forehead and temples without preceding erythema, edema, or desquamation.
  
  
  METHODS
  We conducted a retrospective review of 25 children with similar clinical findings, seen from 2009 to 2013, from 5 medical centers in 3 countries.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The age of our patients precluded patch testing and/or invasive diagnostic methods.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Hospital Infantil del Niño Jesús, Madrid, Spain. Electronic address: ahernandez_hnj@yahoo.es.
authors.forename: Angela
authors.initials: A
authors.lastname: Hernández-Martín
authors.affiliation: Department of Dermatology, Palo Alto Medical Foundation, Palo Alto, California.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Gilliam
authors.affiliation: Department of Dermatology, Hospital Santa Creu i San Pau, Barcelona, Spain.
authors.forename: Eulalia
authors.initials: E
authors.lastname: Baselga
authors.affiliation: Department of Dermatology, Hospital San Joan de Deu, Barcelona, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Vicente
authors.affiliation: Departments of Pediatrics and Dermatology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lam
authors.affiliation: Department of Dermatology, Hospital San Joan de Deu, Barcelona, Spain.
authors.forename: Maantonia
authors.initials: M
authors.lastname: González-Enseñat
authors.affiliation: Department of Pathology, Hospital Infantil del Niño Jesús, Madrid, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azorín
authors.affiliation: Department of Dermatology, Hospital Infantil del Niño Jesús, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Torrelo
mesh_terms: D000367:Age Factors; D001707:Biopsy, Needle; D001955:British Columbia; D002140:California; D002675:Child, Preschool; D015331:Cohort Studies; D005148:Facial Dermatoses / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017495:Hyperpigmentation / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D007150:Immunohistochemistry; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013030:Spain; D013997:Time Factors
keywords: acquired facial macular hyperpigmentation; children; face; hyperpigmented macules