ARTICLE
Physiological
cutaneous variations observed during the early months of life can be classified
together under the term transient benign dermatoses of infancy (TBDI). Adding
to previously described anomalies of pigmentation during the course of TBDI,
we report 54 cases of physiological hyperpigmentation of the posterior aspect
of the third joint segment of the fingers in Caucasian neonates and infants.
To our knowledge, this is the first report of this color variation in Caucasian
neonates.
Methods
Between December 1, 1999, and March 1, 2000, 153 consecutive children
(58 girls and 95 boys) from 0 to 6 months of age were examined in the
Pediatrics department during a hospital stay. None of the children had
been hospitalized for a cutaneous disorder or for jaundice. For each child,
two of the authors examined the perionychium and posterior aspect of the
third joint segment for hyperpigmentation. The 153 subjects constituted
a homogeneous group of Caucasian neonates and infants from native Northern
European, Italian and Turkish families. The intensity of such hyperpigmentation
was graded as absent, mild, moderate or intense. A group of 52 children
more than one year old, who were hospitalized or seen as out-patients,
served as a control group.
Results
Among the one hundred and fifty-three children under 6 months of age,
benign digital pigmentation was observed in fifty-four. The latter group
consisted of eighteen girls and thirty-six boys (sex ratio close to that
of the whole cohort), the average age of whom was 69 days. The fingers
were examined using Wood's light, which accentuates this light brown or
ochre pigmentation situated between the proximal edge of the nails and
the dorsal distal interphalangeal zone (Fig.
1). The hyperpigmentation was mild in thirty-one, moderate in
twenty and intense in three. Comparison of the prevalence of this pigmentation
by age bracket (Table I)
shows that it was always more frequent in the neonates and infants than
in the control group of older children except in the subgroup older than
one month and younger than two months (X2 test and Fisher's
exact test). This limited series tends to indicate that the prevalence
of this hyperpigmentation is maximum between the ages of 2 and 6 months
and that it declines before the age of one year. We did not systematically
look for other hyperpigmented zones in these children, but the same type
of pigmentation was often observed in the toes.
CONCLUSION
Comments
TBDI including modifications of pigmentation have been reported in newborn
children of all ethnic origins [1-6]. A single publication [6] mentions
the existence of transient pigmentation of the perinychium and the dorsal
aspect of the third joint segment in 23% of premature black neonates.
Digital hyperpigmentation which is probably frequent in black newborns
(Fig. 2) as is hyperpigmentation
of the external genitalia and the areola, is analogous to the less marked
pigmentation that we observed in the present group of infants. In some
of the children, this pigmentation was noted during the first days of
life. This observation weakens the hypothesis that such pigmentation might
involve rubbing against fabrics. The fact that such coloration is usually
lacking in intensity probably explains why it is not mentioned in studies
of physiological skin variations among European newborns [7]. It may easily
go unnoticed. The lesions observed during acromelanosis progressiva [8]
are blue-black and extensive, they are thus very different from the digital
pigmentation that we observed. This transient physiological finger pigmentation
should be added to the list of TBDI, which are often a source of anxiety
for parents [9].
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