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Based on the image of the infant's back, showing multiple hyperpigmented macules and nodules, here’s a differential diagnosis (DDx) list:
| Condition | Key Features |
|---|---|
| Congenital Dermal Melanocytosis (Mongolian spots) | Blue-gray patches, common on back and buttocks; usually benign. |
| Diffuse Cutaneous Mastocytosis (DCM) | Multiple hyperpigmented macules or plaques; may urticate (Darier sign positive); possible systemic symptoms. |
| Neurofibromatosis Type 1 (NF1) | Café-au-lait spots, axillary freckling, neurofibromas later; typically larger, uniform color. |
| Congenital Melanocytic Nevi | Dark brown to black plaques or nodules; may have irregular borders and hair growth. |
| Incontinentia Pigmenti (late stage) | Hyperpigmented whorls or patches, following Blaschko lines, often preceded by vesicular stages. |
| Langerhans Cell Histiocytosis (skin-limited form) | May present with crusted papules, nodules, or petechiae; systemic involvement possible. |
🔎 High Suspicion based on Image:
The multiple, somewhat raised, hyperpigmented lesions, some nodular, strongly suggest Diffuse Cutaneous Mastocytosis (DCM) — especially if Darier sign (urtication or swelling after rubbing a lesion) is positive.
Next Step: Check for Darier sign and monitor for systemic symptoms (e.g., flushing, diarrhea).
Would you like me to also suggest a quick diagnostic workup plan or a mnemonic to remember this DDx list? 🎯
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