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What's causing my toddlers skin fold hyperpigmentation?

Answered on August 19, 2014
Created August 28, 2011 at 7:14 PM

My son is 2.5 years old and is still breastfeeding, he does eat solids, but not as much as his 3.5 year old sister.

He was a difficult baby to say the least. He is still quite a high need toddler and we are trying to work out what his issues are. I found paleo due to researching about my own and his health issues.

It seems that he has an intolerance to dairy and perhaps other foods that we're unaware of. We eat mainly paleo, but we sometimes deviate. He has eczema which has improved considerably since we've started to eat paleo (flaxseed supplementation helped me with my keratosis pilaris, but didn't make much of a difference to his skin at all).

The issue that I'm a little concerned with at the moment is that he has darkened skin in his armpit and I think a little on his elbow creases.

My background (it's long and complicated, so condensed here) is that I was diagnosed with type 2 diabetes about 8 years ago. My DD is 3.5, her pregnancy wasn't complicated, but I did take a multivitamin throughout and had major nausea and food aversions. With DS, I ended up in hospital at 28 weeks with polyhydramnios and vomiting due to a suspected UTI (I don't think that was the case & think it may have been a different type of infection). Blood tests showed that I was anaemic and had raised CRP. I was given IV antibiotics and then prophlactic anti b's.

Food wise, I was eating SAD (SUKD ;-) and injecting insulin - blood sugar levels were all over the place and I had quite a lot of hypos (HbA1c was 5.7, but with amount of hypos, no doubt levels were high enough!) and then having to down glucose tabs (or chocolate) when they occured.

So, I was in a bit of a mess really :-(

My son was born at 7lb 4oz @ 37 + 6 weeks so not a huge baby by any means - 25th centile (same as my DD). From 6 months onwards, he slowed his weight gain and dropped to the 0.4th centile - he has moved up from this when we started paleo eating to around 15th centile. He is small. He has the signs of an allergic child - dark circles under eyes (he had them before we started to wean), dennie-morgan lines, he had horrible nappy (diaper) rash before weaning and we once had to use an antifungal cream to clear it up :-( His poops were always light in colour - they normalised when I went LC paleo. The poops also correlated to certain foods he eats, but not totally sure (suspect wheat and tomatoes) which ones.

We've been to the doctors many times (UK, NHS) - first time for reflux, doctor didn't want to know unless he was losing weight. Again, we asked for coeliac testing, doctor not concerned as he was on steady centile (0.4th). Second doctor did refer us to dermatology on account of skin rashes. We had an appointment this Monday gone. Nurse going to refer us to dietitian and perhaps have food allergy tests.

But, the hyperpigmentation... I'm concerned that there's something going on that I'm missing. Is this a cascade of symptoms that is more serious than just a few food intolerances/allergies?

FWIW, I also have skin fold discolouration (dunno if it is acanthosis nigricans as it's very light, not as google images shows) and have had this for many years - probably since pre-teens (I'm 35).

Sorry about the long info, I think I wanted to try and include as much as possible.

Hack my sons skin fold discolouration please :-)

C4134ed417dbc0a6b79ab2cee32632d3

(1811)

on August 28, 2011
at 10:14 PM

I don't think that this is acanthosis nigricans (and yes, realise I'd mispelled that, oops!) as it really is just discolouration of the skin, no velvety feel and no rash. The eczema has left different pigmentation on his legs, but this is differernt to the eczema. He has never complained of itching from the eczema at all. Thanks for the screening test list, I will be speaking to our docs (we need to be referred to hospital for blood tests for paediatric patients in the UK) and asking for advice too :-)

C4134ed417dbc0a6b79ab2cee32632d3

(1811)

on August 28, 2011
at 10:10 PM

Thank you. I think that the problems lie with my pregnancy with him and *my* nutritional status (it goes back a long, long time). Unfortunately, he has decided that he "don't like meat mammy", but will eat liver pate (I'm afraid that I'm not a big fan of organ meats apart from pate, but I do like fatty fish! Luckily, the boy likes his eggs :-) We don't have any reflux symptoms at all, it was only when he was a baby that this happened. Zinc deficiency is possibly a very likely thing as I did develop (more) stretchmarks during his pregnancy, I didn't with DD at all, but had some previously.

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3
Eecc48184707bc26bce631485b5b7e34

on August 28, 2011
at 08:13 PM

Some things that come to mind as possibly related with hyperpigmentation of various places on the skin:

riboflavin deficiency (possible)

zinc deficiency (very likely)

b12 deficiency (unlikely)

there may be more, that's just what I could come up with off the top of my head.

Please be sure you're getting sufficient b vitamins and zinc from organ meats (liver once a week but not just liver as it's possible to get too much A and copper with excessive consumption). Muscle meats alone will not supply enough B vites and zinc.

It's also, per Chris Masterjohn and other sources, to have enough glycine (usually from bone/connective tissue stock) to balance out the methionine/tryptophan consumption of muscle meat. I try for one muscle meat meal, one bone stock meal, and 2 egg yolks per day in addition to plant foods. Several times a week, eat fatty fish instead of the muscle meat.

Fermented foods, coconut oil, butter in addition to the plants and animal foods above.

There could be many things going on here like subclinical infection etc. However, know that it's very likely, he will slowly improve over time just with great nutrition. My 10 yo was definitely in that boat at 3.5. She was a mess. Over the last years she improved - though the reflux has held on. Just in the last year her dark circles finally retreated and we're now working meticulously on the reflux with good results.

Best, Katherine

C4134ed417dbc0a6b79ab2cee32632d3

(1811)

on August 28, 2011
at 10:10 PM

Thank you. I think that the problems lie with my pregnancy with him and *my* nutritional status (it goes back a long, long time). Unfortunately, he has decided that he "don't like meat mammy", but will eat liver pate (I'm afraid that I'm not a big fan of organ meats apart from pate, but I do like fatty fish! Luckily, the boy likes his eggs :-) We don't have any reflux symptoms at all, it was only when he was a baby that this happened. Zinc deficiency is possibly a very likely thing as I did develop (more) stretchmarks during his pregnancy, I didn't with DD at all, but had some previously.

3
6426d61a13689f8f651164b10f121d64

(11478)

on August 28, 2011
at 09:10 PM

Efaitch,

This may be a hard question to hack on a Q&A website, because the differential diagnosis of skin hyperpigmentation is huge, as is the differential of acanthosis nigricans.

The first key question is--is the rash really acanthosis nigricans? Look at the rash closely. Is the skin thickened? Does it have a "velvety" feel to it? Does the area itch at times? True acanthosis is rare in toddlers, while atopic eczema is very common. Eczema tends to be itchy, while it is uncommon for acanthosis nigricans to itch. It is also common for skin to be hyperpigmented after eczema clears up. This is called post-inflammatory hyperpigmentation. As Katherine points out, dietary deficiencies can also cause skin hyperpigmentation.

Your request for a celiac screen was entirely appropriate in this situation. I would also add the following screening tests:
--fasting blood sugar and insulin levels
--hemoglobin A1C
--thyroid-stimulating hormone (TSH)
--free T4
--AM cortisol

C4134ed417dbc0a6b79ab2cee32632d3

(1811)

on August 28, 2011
at 10:14 PM

I don't think that this is acanthosis nigricans (and yes, realise I'd mispelled that, oops!) as it really is just discolouration of the skin, no velvety feel and no rash. The eczema has left different pigmentation on his legs, but this is differernt to the eczema. He has never complained of itching from the eczema at all. Thanks for the screening test list, I will be speaking to our docs (we need to be referred to hospital for blood tests for paediatric patients in the UK) and asking for advice too :-)

1
Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on August 29, 2011
at 01:58 AM

I had tinea versicolor on one underarm, due to using an alcohol based deodorant that messed up my skin pH.

It took a couple of months, but it did clear up completely with topical coconut oil.

Have you had his Vitamin D tested? My chronic eczema cleared right up in 3 months after supplementing with Vitamin D3 to sufficiency, pre-Primal.

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