eMedicine Specialties > Dermatology > Pediatric Diseases

Piebaldism: Differential Diagnoses & Workup

Author: Michael D Fox, MD, Attending Physician, Department of Emergency Medicine, Marin General Hospital
Coauthor(s): Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Contributor Information and Disclosures

Updated: Jan 30, 2009

Differential Diagnoses

Addison Disease
Vitiligo
Albinism
Vogt-Koyanagi-Harada Syndrome
Alezzandrini Syndrome
Waardenburg Syndrome
Leprosy
Yaws
Skin Lightening and Depigmenting Agents
Systemic Sclerosis
Tinea Versicolor

Other Problems to Be Considered

Chemical leukoderma
Onchocerciasis
Preus syndrome
Pinta
Vitiligo (distinguished by the presence of lesions from birth, hyperpigmented macules of depigmented and normal skin, and static course)
Yaws (frambesia tropica)
Ziprkowski-Margolis syndrome

A screening program to detect Waardenburg syndrome among 1763 deaf individuals throughout Colombia identified 95 affected individuals belonging to 95 families, giving a frequency of 5.38% of Waardenburg syndrome among the institutionalized deaf population.9 Overall, among the 95 propositi, the most frequent features were broad nasal root (58.9%), a first-degree relative affected (37.9%), heterochromia irides (36.8%), skin hypopigmentation (31.6%), white forelock (28%), intense blue iris (27.4%), synophrys (12.6%), premature graying (10.5%), ptosis of the eyelids (9.5%), and hypoplasia alae nasi (1.1%).

More on Piebaldism

Overview: Piebaldism
Differential Diagnoses & Workup: Piebaldism
Treatment & Medication: Piebaldism
Follow-up: Piebaldism
Multimedia: Piebaldism
References

References

  1. Ezoe K, Holmes SA, Ho L, et al. Novel mutations and deletions of the KIT (steel factor receptor) gene in human piebaldism. Am J Hum Genet. Jan 1995;56(1):58-66. [Medline].

  2. Richards KA, Fukai K, Oiso N, Paller AS. A novel KIT mutation results in piebaldism with progressive depigmentation. J Am Acad Dermatol. Feb 2001;44(2):288-92. [Medline].

  3. Tosaki H, Kunisada T, Motohashi T, Aoki H, Yoshida H, Kitajima Y. Mice transgenic for Kit(V620A): recapitulation of piebaldism but not progressive depigmentation seen in humans with this mutation. J Invest Dermatol. May 2006;126(5):1111-8. [Medline].

  4. Spritz RA. "Out, damned spot!". J Invest Dermatol. May 2006;126(5):949-51. [Medline].

  5. Jan IA, Stroedter L, Haq AU, Din ZU. Association of Shah-Waardenburgh syndrome: a review of 6 cases. J Pediatr Surg. Apr 2008;43(4):744-7. [Medline].

  6. Ruan HB, Zhang N, Gao X. Identification of a novel point mutation of mouse proto-oncogene c-kit through N-ethyl-N-nitrosourea mutagenesis. Genetics. Feb 2005;169(2):819-31. [Medline].

  7. Chow RK, Stewart WD, Ho VC. Graft-versus-host reaction affecting lesional skin but not normal skin in a patient with piebaldism. Br J Dermatol. Jan 1996;134(1):134-7. [Medline].

  8. Matsunaga H, Tanioka M, Utani A, Miyachi Y. Familial case of piebaldism with regression of white forelock. Clin Exp Dermatol. Jul 2008;33(4):511-2. [Medline].

  9. Tamayo ML, Gelvez N, Rodriguez M, Florez S, Varon C, Medina D, et al. Screening program for Waardenburg syndrome in Colombia: clinical definition and phenotypic variability. Am J Med Genet A. Apr 15 2008;146A(8):1026-31. [Medline].

  10. Njoo MD, Nieuweboer-Krobotova L, Westerhof W. Repigmentation of leucodermic defects in piebaldism by dermabrasion and thin split-thickness skin grafting in combination with minigrafting. Br J Dermatol. Nov 1998;139(5):829-33. [Medline].

  11. Garg T, Khaitan BK, Manchanda Y. Autologous punch grafting for repigmentation in piebaldism. J Dermatol. Nov 2003;30(11):849-50. [Medline].

  12. Desch LW. White forelock could be early sign of tuberous sclerosis. Arch Pediatr Adolesc Med. Jun 1996;150(6):651-2. [Medline].

  13. Falabella R, Barona M, Escobar C, Borrero I, Arrunategui A. Surgical combination therapy for vitiligo and piebaldism. Dermatol Surg. Oct 1995;21(10):852-7. [Medline].

  14. Farag TI, el-Ramly MA, Sakr MF. A Bedouin kindred with 19 piebalds in 5 generations. Clin Genet. Dec 1992;42(6):326-8. [Medline].

  15. Janjua SA, Khachemoune A, Guldbakke KK. Piebaldism: a case report and a concise review of the literature. Cutis. Nov 2007;80(5):411-4. [Medline].

  16. Murakami T, Fukai K, Oiso N. New KIT mutations in patients with piebaldism. J Dermatol Sci. Jun 2004;35(1):29-33. [Medline].

  17. Murakami T, Hosomi N, Oiso N, et al. Analysis of KIT, SCF, and initial screening of SLUG in patients with piebaldism. J Invest Dermatol. Mar 2005;124(3):670-2. [Medline].

  18. Nomura K, Hatayama I, Narita T, Kaneko T, Shiraishi M. A novel KIT gene missense mutation in a Japanese family with piebaldism. J Invest Dermatol. Aug 1998;111(2):337-8. [Medline].

  19. Spritz RA. Molecular basis of human piebaldism. J Invest Dermatol. Nov 1994;103(5 Suppl):137S-140S. [Medline].

  20. Spritz RA. Piebaldism, Waardenburg syndrome, and related disorders of melanocyte development. Semin Cutan Med Surg. Mar 1997;16(1):15-23. [Medline].

  21. Spritz RA, Beighton P. Piebaldism with deafness: molecular evidence for an expanded syndrome. Am J Med Genet. Jan 6 1998;75(1):101-3. [Medline].

  22. Syrris P, Malik NM, Murday VA, Patton MA, et al. Three novel mutations of the proto-oncogene KIT cause human piebaldism. Am J Med Genet. Nov 6 2000;95(1):79-81. [Medline].

  23. Thomas I, Kihiczak GG, Fox MD, Janniger CK, Schwartz RA. Piebaldism: an update. Int J Dermatol. Oct 2004;43(10):716-9. [Medline].

  24. Ward KA, Moss C, Sanders DS. Human piebaldism: relationship between phenotype and site of kit gene mutation. Br J Dermatol. Jun 1995;132(6):929-35. [Medline].

Further Reading

Keywords

piebaldism, partial albinism, familial white spotting, white forelock, poliosis circumscriptum, Waardenburg syndrome, KIT proto-oncogene

Contributor Information and Disclosures

Author

Michael D Fox, MD, Attending Physician, Department of Emergency Medicine, Marin General Hospital
Michael D Fox, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Family Physicians, and California Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Albert C Yan, MD, Section Chief, Associate Professor, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia and University of Pennsylvania
Albert C Yan, MD is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, Society for Investigative Dermatology, and Society for Pediatric Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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