Acquired Facial Hyperpigmented Macules in Infants – Three New Cases and a Short Review

Abstract

 Facial pigmentations in infants are worrisome for parents and families. A definite diagnosis will allow appropriate consultation and – if necessary – treatment. Acquired facial hyperpigmented macules in infants (AFHM) is an entity first described in 2014, mainly in infants and young children of Chinese or Mediterranean origin.We evaluated infants from Romania with AFHM.
We present three new cases of AFHM in Caucasian infants from Romania and performed a narrative literature search on Pubmed© database. The infants were 6, 14, and 24 months old (medium 14.7 months), a boy and two girls. They presented with irregular macules mainly on the forehead, although some macules were observed on the bridge of the nose, while extrafacial hyperpigmentation was absent. The lesions were brownish and asymptomatic. A short time course with mild topical corticosteroids or emollients had no effect. Follow-up was six months. In the literature research, we identified 261 cases worldwide with a male to female ratio of 1.4. Most case reports came from China followed by the Mediterranean region. There were no reports from Central, Eastern or Northern Europe. More than 90% of Chinese cases show a complete clearance after several years. According to published data the disease seems to be limited to preschoolers. In contrast, AFHM remained persistent in mixed American and European populations for up to 4.5 years. Stringent data on pathogenesis of AFHM are not available. Treatment options may include sun protection, but this has not been validated. Further studies are needed. AFHM seems to be more common in patients with Chinese and Mediterranean background. Among Chinese patients the course of the disease is benign and self-limited, while data from mixed non-Chinese patients suggest a longer persistence.