Pigmentation Disorders in Children: What You Should Know

Nevi, spots, or freckles are some of the pigmentation disorders that children may experience. Learn to recognize them and what care to offer your children when you detect them.
Pigmentation Disorders in Children: What You Should Know
Maria del Carmen Hernandez

Reviewed and approved by the dermatologist Maria del Carmen Hernandez.

Last update: 22 December, 2021

Pigmentation disorders are a group of common dermatoses in children. Although they’re usually benign, the finding of a pigmented lesion on a child’s skin may indicate the presence of some disease.

Do you want to learn more about the subject of pigmentation disorders in children? Then we invite you to check out the following article.

Pigmentation disorders in children

The type and amount of pigment that the cells of the epidermis–the outermost layer–contain determine the color of the skin. Melanin is the natural pigment in our body and provides color to the skin, hair, and eyes.

Pigmentation disorders in children can occur due to an increase in the amount of pigment (melanoderma) or a decrease in it (leukoderma). Next, we’re going to describe each of these conditions and what they’re due to.


Leukoderma refers to a decrease or loss of skin pigmentation, which occurs for various reasons. The vast majority of the time, they’re acquired injuries and occur after inflammation.

1. Vitiligo

A child with vitiligo on her leg standing on the beach.

Vitiligo is one of the most common pigmentation disorders that occur in children. It results from the loss of epidermal melanocytes and manifests itself through white spots with well-defined borders.

Another characteristic is that the lesions are distributed symmetrically in the hands, forearms, and feet. They almost always affect the skin of the face, in the perioral and periocular areas.

According to a recent review in the journal Dermatology, this condition is associated with certain autoimmune disorders, such as those that affect the thyroid gland.

2. Pityriasis alba

Pityriasis alba is a common and benign pigmentation disorder that involves the presence of rounded, hypopigmented, and slightly scaly lesions.

Most children with it have a history of atopy. For this reason, experts assume that pityriasis could be a minor manifestation of atopic dermatitis.

The spots are mainly located on the arms, on the face, and on the upper part of the trunk. They seem to be more noticeable on darker skin, as exposure to the sun accentuates them.

3. Albinism

Albinism is a group of inherited conditions, which have to do with the absence or decrease of melanin in the skin, eyes, or hair.

It involves the presence of white hair, white skin, white eyelashes, and pink eyes.

Because children with albinism are especially susceptible to sun damage, they should constantly wear sunscreen to avoid further damage.

4. Piebaldism

Piebaldism is a rare inherited disorder that affects both men and women. It involves the appearance of a triangular white skin area, located in the central part of the forehead.

This disease doesn’t present manifestations elsewhere in the body and the skin lesions are benign. However, the physical appearance of the child may condition their emotional and social well-being.

5. Pityriasis versicolor

Pityriasis Versicolor is a fairly common and benign fungal infection of the skin surface. Its clinical manifestations include hyper- or hypopigmented macules, with slight scaling.

The most frequently affected areas are the neck, trunk, and extremities.

It’s interesting to note that the fungus that produces it is part of the normal flora of the skin and inhabits oily areas. However, in the event of a change in the composition of this tissue, it can become a pathogen. Among the most frequent causes that favor this condition, the following stand out:

  • Pregnancy
  • The frequent application of oily lotions or creams
  • Genetic predisposition
  • Certain environmental conditions, such as heat and humidity
  • Immunodeficiencies


Melanodermias are skin pigmentation disorders that involve an increase in melanin. This condition manifests itself as brown, bluish, or orange-colored lesions, depending on the location.

Next, we’ll describe some of the most frequent.

1. Café au lait birthmarks

Type 1 neurofibromatosis is characterized by the presence of multiple café-au-lait spots, which are homogeneous in appearance and well defined.

This disease involves other extra-cutaneous manifestations, such as neurofibromas, Lisch nodes, and optic gliomas.

2. Ephelides

These are better known as freckles and appear more frequently in those areas of the body exposed to the sun’s rays.

They’re small, brownish-colored, hyperpigmented lesions that are modified by photo exposure.

A dermatologist looking a moles on a young man's back.

3. Becker melanosis

Finally, Becker’s nevus is a late-onset, benign, acquired hyperpigmented lesion. It occurs more frequently in boys and during puberty.

For this reason, experts suggest that one of the probable determinants of this condition could be an increase in sensitivity to androgens.

Pigmentation disorders in children and dermatological control

To conclude, pigmentation disorders are the lesions that are behind the greatest number of dermatological consultations in children.

Due to the importance of their follow-up over time, annual dermatological controls are essential. Through observation, it’s possible to evaluate their evolution and offer the necessary treatments at the most opportune moment.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology. 2020;236(6):571-592. doi: 10.1159/000506103. Epub 2020 Mar 10. PMID: 32155629.
  • Prohic A, Jovovic Sadikovic T, Krupalija-Fazlic M, Kuskunovic-Vlahovljak S. Malassezia species in healthy skin and in dermatological conditions. Int J Dermatol. 2016 May;55(5):494-504. doi: 10.1111/ijd.13116. Epub 2015 Dec 29. PMID: 26710919.
  • Kim YJ, Han JH, Kang HY, Lee ES, Kim YC. Androgen receptor overexpression in Becker nevus: histopathologic and immunohistochemical analysis. J Cutan Pathol. 2008 Dec;35(12):1121-6. doi: 10.1111/j.1600-0560.2008.00988.x. PMID: 18616760.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.