RT Book, Section A1 Collier, Sigrid M A1 Krejci-Mannwaring, Jennifer A1 Usatine, Richard P. A2 Usatine, Richard P. A2 Sabella, Camille A2 Smith, Mindy Ann A2 Mayeaux, E.J. A2 Chumley, Heidi S. A2 Appachi, Elumalai SR Print(0) ID 1114877920 T1 Disorders of Hyperpigmentation T2 The Color Atlas of Pediatrics YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 978-0-07-176701-9 LK accesspediatrics.mhmedical.com/content.aspx?aid=1114877920 RD 2024/10/10 AB A 7-year-old African American girl was brought to her pediatrician by her mom who was worried that she was itching and that her skin was getting darker. The pediatrician knew the girl well as a patient with asthma and allergic rhinitis. In fact, the girl performed the allergic salute more than once in the office as she rubbed her itchy nose. Morgan-Dennie lines were seen under her eyes (Figure 168-1A). The mom undressed the girl to show the dark patches of skin around her knees (Figure 168-1B). Atopic dermatitis is common in the popliteal fossae and this girl clearly demonstrated the atopic triad: atopic dermatitis, asthma, and allergic rhinitis. The darkening of the skin around the knees and also seen on the neck is related to the scratching and rubbing of the skin secondary to the pruritus of atopic dermatitis. The pediatrician explained to the mom and child about the need to more aggressively treat the atopic dermatitis with emollients and topical steroids. No promises were made about the reversibility of the hyperpigmentation as each patient will respond differently to treatment.