Erythema Dyschromicum Perstans In a Caucasian Pediatric Patient

A 15-year-old Caucasian male presented to our clinic with a 1.5-year history of widespread gray and red patches that began on his trunk and later spread to his neck and extremities (Figures 1 and 2). The lesions were completely asymptomatic and had been stable for several months. There was no history of new medications, previous lesions in this distribution, or associated systemic symptoms. The patient’s mother denied the presence of any Hispanic, Asian, or African heritage in her son.

On physical examination, the patient had round-to-oval, blue-gray patches primarily on his trunk, with additional involvement of his neck and extremities and minimal involvement of the jawline. There was no involvement of the palms, soles, or mucous membranes. A rapid plasma reagin test was negative.

Biopsy of a blue-gray patch on the abdomen showed interface dermatitis and pigmentary incontinence with a histologic differential diagnosis of pityriasis lichenoides chronica, postinflammatory hyperpigmentation, or erythema dyschromicum perstans (EDP). The patient was diagnosed with EDP based on clinicopathologic correlation.

EDP, also known as ashy dermatosis, is characterized by oval, blue-gray macules involving the trunk and spreading centrifugally to the neck, face, and extremities. The macules can become confluent and cover the majority of the body, but generally spare the palms, soles, scalp, nails, and mucous membranes. Lesions may have a raised, erythematous border.^1,2 EDP presents insidiously, is completely asymptomatic, and often has a chronic course.

In adults, the condition is primarily seen in patients of color, most commonly those of Hispanic descent. Few case series have addressed EDP in pediatric patients, but there appear to be significant differences in the racial epidemiology in this subpopulation. In 2005, in a study of 14 cases of EDP in pediatric patients aged 10 years or younger, Torrelo et al reported that 12 of the children were Caucasian.¹ Silverberg et al, in a 2003 case series and literature review, reported 13 of 25 pediatric cases of EDP were in Caucasian children.² These data suggest that pediatric cases of EDP are more common in Caucasians than in patients of color. The case reported here is an example of this.

Unlike their adult counterparts, a majority of children with EDP have been observed to recover significantly or completely over the course of 1 to 3 years.¹ Because of this observation, aggressive treatment of EDP in the pediatric patient remains controversial, though sunscreen and sun avoidance should be universally advised to avoid worsening of dyspigmentation.^1,2 Our patient was managed conserva-