Disorders of pigment are often a significant concern to parents. Even for benign conditions, the cosmetic impact is of importance to patients and families. Hypopigmented lesions may be congenital or acquired, with the latter often occurring in association with inflammation or infection. Congenital lesions appear within the first year of life; as the skin is exposed to sunlight, the normal skin acquires more color and the lesions remain light relative to the normal skin.

• A history of rash or other lesion prior to the development of a hypopigmented area suggests postinflammatory hypopigmentation. This condition resolves with time.

• In patients with vitiligo, there is a positive family history in 30% of cases.

• Half of the cases of vitiligo are present in childhood, usually in adolescence.

• Pityriasis alba is common in children with atopy.

• Ash leaf spots may occur in isolation or in association with tuberous sclerosis.

• Piebaldism is an autosomal dominant condition.

• A hyperpigmented nevus is initially present before the development of a halo nevus.

• Nevoid hypopigmentation, formerly known as Hypomelanosis of Ito, follows the lines of Blaschko in a linear pattern on the extremities and in whorls on the trunk.

• Vitiligo, which may be irregularly shaped, displays hypopigmented and depigmented macules of varying sizes. Vitiligo may involve mucous membranes and hair.

• Patients with piebaldism have a white forelock with hypopigmentation of the adjacent scalp and forehead. The pattern is triangular and enhances with a Wood lamp.

• Ash leaf macules enhance under a Wood lamp.

• Scale frequently accompanies tinea versicolor and may be seen with pityriasis alba. Tinea versicolor infections by Microsporum sp. and Malassezia furfur

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