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Dermatology/black spots all over my daughters body

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eman ali spots 1
eman ali spots 1  

eman ali spots 2
eman ali spots 2  
Respected sir.as i had written in my previous question that my 6 years old daughter syeda eman ali has black spots all over her body which have reached her neck now.we consulted three senior dwrmatologists in rawalpindi pakistan.but they said that its a genetic disorder and they can just wait and pray that these spots disappear within 5 years and dont spoil her face.they said that probably its mactocytosis but even if its mactocytosis even then there isnt any treatment.they advised RIGIX and Atiza syrrups.and emulsification cream for bath.i am now sending you her pictures

Answer
The dark spots are what is called post inflammatory hyperpigmentation. This means that skin irritation from a rash or other caused the increased pigmentation of the skin. The darker lesions are secondary and not a primary skin lesion. So the question is what caused the initial skin lesion.
If your child has mastocytosis there is a treatment.
The treatment of pediatric onset mastocytosis is currently limited to the palliation of symptoms, usually pruritus. The treatment of choice is a classical H1 antihistamine, such as hydroxyzine. In a recent study of hydroxyzine versus ketotifen, hydroxyzine provided substantial relief of pruritus, bullae, flushing, and abdominal pain without significant side effects from the hydroxyzine. In the child who exhibits gastrointestinal symptoms of hyperacidity or ulceration, the addition of an H2 antihistamine may be warranted. The use of oral sodium cromolyn in adult-onset mastocytosis, although having shown no effect on urine histamine and N-methylimidazole acetic excretion, had ameliorated gastrointestinal symptoms of diarrhea, abdominal pain, nausea, and vomiting. No improvement in symptoms of flushing, urticaria, headache, or bone pain was observed. That study and the known pathophysiology of gastrointestinal-system involvement in mastoctosis suggests that the use of oral sodium cromolyn in pediatric patients with gastrointestinal symptoms is reasonable, but documentation of efficacy requires a formal study utilizing a double-blind placebo-controlled design with crossover. A previous study of three children with pediatric-onset mastocytosis suggested improvement in both gastrointestinal symptoms (100%) and non-gastrointestinal symptoms(pruritus, 66%; wealing, 33%), but the protocol of that study did not control for maturational improvement.

Rarely, infants with pediatric-onset mastocytosis may develop a shock-like illness accompanied by bullous eruptions and gastrointestinal hemorrhage. These infants require intensive care support with treatment with both H1 and H2 antihistamines as well as corticosteroids to correct the systemic effects of the massive mast cell mediator release. In patients with adult-onset disease, epinephrine has been useful in reversing severe hypotension unresponsive to antihistamines and fluid administration. This treatment appears to be reasonable for children with severe hypotension unresponsive to standard therapy.

The use of topical corticosteroids to aid the resolution of skin lesions has shown some efficacy, although widespread and long-term use of potent topical corticosteroids may cause hypothalamic-adrenal suppression in young infants. This treatment should only be undertaken in severely affected children and in conjunction with a physician experienced in high potency topical steroid use in children.

Treatment of the bullae that may occur in children less than 2 years of age is similar to that of a scald injury: local care and prevention of infection. Bullae heal without scarring but may leave an area of hyperpigmentation. Intravenous steroids have been reported to be useful in the treatment of severe and progressive bullae of infantile urticaria pigmentosa. In the child with isolated mastocytomas with resultant severe systemic symptoms from mast cell mediators, surgical excision of the mastocytoma may be the treatment of choice, although the majority of mastocytomas spontaneously resolve after several years.  

Dermatology

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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