Case Report
A 4-year-old girl presented with rash on her face that was noticed by
her mother since 1 month following birth. She was 3rdof the 5 children born at full term via normal vaginal delivery at home
to consanguineous parents. Initially, the mother noticed erythematous
macules and plaques on bilateral cheek that gradually developed areas of
hypopigmentation and telangiectasia within 6 months (Fig 1a). Lesions
with similar morphology and progression appeared to involve shoulder
(Fig 1b) followed by V-area of neck after a year that was aggravated on
exposure to sunlight. There was no history of hair loss, recurrent
respiratory infection, oral ulcer, feeding problems, dental, ocular or
neurological symptoms. On family history (as presented by pedigree in
Fig 2) there was demise of a 4th child at birth and
history of similar skin lesion on 8 months old 5thchild who developed the lesions at 2 months following birth (Fig. 1a).
On cutaneous examination, there were multiple ill-defined erythematous
plaques on bilateral cheek, dorsum of nose, V-area of neck and right
shoulder with areas of dyspigmentation, atrophy and telangiectasia.
Height of the child was less than 3rd percentile for
age and weight was at 10th percentile for age (as per
WHO growth chart). There was no abnormalities detected on systemic
examination. Baseline complete blood count, Anti-nuclear antibody,
Comprehensive metabolic panel and X-ray of bilateral hand was normal.
Karyotype analysis and gene sequencing was not done due to
unavailability. RTS was diagnosed, and the patient was advised for
sun-protective behaviors and annual evaluation for the eyes, skin and
bone.