White spots on the child's hands

The situation of small white spots on children's hands is not very serious, but white patches on children's hands should be taken seriously. Because the appearance of white spots is quite consistent with the symptoms of vitiligo, once the disease occurs, it will have a very serious impact on children. Although it is not necessarily vitiligo, given its harmfulness, we still need to understand this disease first and determine whether the child has this disease.

There is no significant difference in the clinical manifestations of vitiligo between genders. It can occur in all age groups, but it is more common in adolescents. The skin lesions are depigmented spots, which are often milky white but can also be light pink, with a smooth surface and no rash. The boundaries of the white spots are clear, the pigmentation of the edges is increased compared to normal skin, and the hair inside the white spots is normal or whitened. The lesions often occur in areas exposed to sunlight and damaged by friction, and are often distributed symmetrically. White spots are often distributed according to nerve segments and arranged in bands. In addition to skin lesions, the mucous membranes of the lips, labia, glans penis and inner foreskin are also often affected.

Most patients have no subjective symptoms, and a small number of patients experience local itching in the affected area before or during the onset of the disease. Vitiligo is often accompanied by other autoimmune diseases, such as diabetes, thyroid disease, adrenal insufficiency, scleroderma, atopic dermatitis, alopecia areata, etc. The specific classification is as follows: 1. Localized type (1) Focal type: one or more white spots are limited to one area, but are not distributed in segments; (2) Unilateral type (segmental type): one or more white spots are distributed in segments and suddenly disappear in the midline; (3) Mucosal type: only the mucosa is affected. 2. Scattered type (1) Common type: widespread and scattered white spots; (2) Facial acral type: distributed on the face and limbs; (3) Mixed type: mixed distribution of segmental type, facial acral type and/or common type. 3. Generalized total or almost total depigmentation. More than 90% of vitiligo is of the scattered type, and among the remaining vitiligo, localized vitiligo is more common than generalized vitiligo. According to the degree of pigment loss in the lesions, the disease can be divided into complete and incomplete types. The former has a negative reaction to dihydroxyphenylalanine (DOPA), melanocytes disappear, and the treatment response is poor. The latter reacts positively to DOPA, and the melanocytes do not disappear but only decrease in number, so the chance of cure is high.

Differential diagnosis 1. Anemic nevus occurs in childhood and is mostly seen on the face. It is a light-colored spot that does not turn red when stimulated or rubbed, but the surrounding skin turns red. 2. Pityriasis alba may be related to dry skin and sun exposure, and manifests as hypopigmented spots with unclear edges and a small amount of white scales on the surface. 3. Non-pigmented nevus occurs at birth or shortly after birth. The skin lesions are localized pale white spots with jagged edges. 4. Tinea versicolor lesions occur on the trunk and upper limbs. They are pale white round or oval spots with unclear boundaries and fine scales on the surface. Fungal tests are positive. 5. Albinism is a congenital non-progressive disease, often with a family history. The skin and hair all over the body lack pigmentation, the irises of both eyes are transparent, and the choroidal pigment disappears, making it easy to distinguish from vitiligo. 6. Leprosy leukoplakia is an incomplete hypopigmented macules with unclear borders, loss of surface sensation, and other symptoms of leprosy. 7. The leukoplakia of secondary syphilis occurs on the neck, is not pure white, and the syphilis serum reaction is positive. 8. Other diseases should also be differentiated from discoid lupus erythematosus, mucosal leukoplakia, etc.

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