| Summary: | A 5-year old girl was addressed to us at the request of pediatrician for hyperpigmented macules, slight brown, with no pruritus, no inflammatory rim, well demarcated, on the right side of mandibular area and preauricular. Mother declared that she had observed the lesions two weeks before the visit to Pediatric Department and the skin modifications were exactly as at the moment of our investigation. No inflammation, no red papules or macules, no scratch marks from pruritus, any symptoms to be correlated with. The gold ear rings were fixed immediately after birth. No history of atopy or other allergic reactions, no skin diseases in the past of the child. At the moment of admission at the dermatology Department the girl was healthy, under no medication and the physical examination was within normal limits. All the usual lab investigations were also normal; an allergy test to nickel was negative. A treatment with Azelaic Acid 15% was started once daily during evenings associated with 50+ UVA and UVB photoprotection, but with no results after 3 weeks of continuous therapy. A new attempt with Hydroquinone cream was interrupted just after 2 weeks of administration for the lack of response.
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