Ashy dermatosis in an 8-year-old Indian child
An 8-year-old dark-skinned female child of Indian origin presented to the dermatology outpatient department with asymptomatic, gradually progressive hyperpigmented flat lesions over the trunk of 1-year's duration. There was no history of mustard oil application or use of drugs prior to the onset of lesions. There was no complaint of pruritus, fatigue, or symptoms suggestive of any systemic disease.\nThe general and systemic examination did not reveal any abnormality. Cutaneous examination revealed ashy gray-colored, confluent, symmetrical macules with polycyclic margins over almost the entire trunk, proximal upper limb, posterior neck, proximal thigh, forehead, and left upper eyelid [Figure and ]. Only a few lesions could be discerned as isolated lesions, which were variable in size, from 0.5 cm to 2.0 cm. An erythematous border could not be discerned. The mucous membrane, palms, and soles and nails were normal. The results of blood and stool examination including liver function tests were normal. The hemoglobin was 13 gm/dl. The skin biopsy showed focal vacuolar alteration of basal layer with mild to moderate infiltrate of lymphocytes and histiocytes intermixed with melanophages in the dermis, which was characteristic of ashy dermatosis and also lichen planus pigmentosus and other conditions with lichenoid histopathology []. A diagnosis of ashy dermatosis was made on the basis of the clinical and histological findings. The patient was advised photoprotection with a broad-spectrum sunscreen as well as tablet dapsone 25 mg daily after performing G-6-P-D estimation and liver function tests. A mild subjective decrease in the pigmentation was seen after 4 weeks of treatment. However, then the patient was lost to follow up.