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Case 1: Hyperpigmented swirly patches in a toddler.

A previously healthy eight-month-old female Chinese infant presented with hyperpigmented swirly patches over the abdomen and legs for the past two months. Two weeks before her visit, the infant developed a vesicular eruption within the hyperpigmented streaks, which the mother photographed (Figure 1). This eruption coincided with a febrile upper respiratory tract infection. 
 
 
 
Figure 1) 
 
Vesicles in a linear distribution overlying hyperpigmented streaks 
 
 
 
Medical history revealed that the patient was born to nonconsanguineous parents following a normal pregnancy and delivery. At birth, she exhibited a vesicular eruption that resolved within the first few weeks of life. This was the family’s first pregnancy, with no history of previous miscarriages. The patient was otherwise healthy, with no history of seizures, developmental delay, delayed dentition or nail abnormalities. No one in the family had similar findings. 
 
On examination, the patient appeared well. She had a normal neurological, respiratory, cardiac and abdominal examination. The cutaneous examination revealed multiple hyperpigmented patches over the abdomen and legs in a swirled pattern along Blashko’s lines (Figure 2). There were no residual vesicles or other cutaneous changes, and no nail dystrophy. 
 
 
 
Figure 2) 
 
Hyperpigmented swirly patches following the lines of Blashcko on the trunk 
 
 
 
The hyperpigmented streaks, the recent vesicular eruption and photographs from birth confirmed the diagnosis.