In 1990, Chitayat et al. [19901 reported a case of Hypomelanosis of Ito (HI) associated with trisomy 18 mosaicism. We recently observed a similar association in an 1 1-year-old girl. She was the third child of a 45-year-old mother and 50year-old father, both healthy and unrelated. The family history was unremarkable. Pregnancy was complicated by poor fetal movements and delivery was at 35 weeks gestation by cesarean section. Birth weight was 2,200 g (10th centile), length 47 cm (50th centile) and head circumference 31 cm (< 3rd centile). She presented hypopigmented macules in a whorled or "marblecake" configuration following the lines of Blaschko on the anterior and posterior part of the trunk. An orthopedic examination showed left hip joint luxation. Subsequently her psychomotor development was severely delayed.At age 11 years she weighed 27.5 kg (10th centile); height was 129 cm (3rd centile) and head circumference 49.5 cm (< 3rd centile). A slight facial asymmetry with left hypoplasia, marked defective implantation of the teeth and dorsal scoliosis were noted. Neurologically, she showed severe mental retardation, hypotonia, generalized hyperreflexia, gait ataxia and intention tremor. Bone age, basic laboratory tests (including hematology, blood chemistry, serum electrolytes, and urinanalysis) and EEG tracings were normal. CT scan showed generalized cerebral atrophy. Skin histopathology using the Fontana-Masson method disclosed a reduced amount of melanin granules in the basal layer of the dermis. Electron microscopy showed a reduced number of melanosomes in the basal melanocytes which were also smaller in size. Thus the skin features were consistent with HI.Chromosome analysis using QFQ banding showed trisomy 18 mosaicism with the trisomic cell line occurring in 73% of peripheral blood lymphocytes, 12% of the fibroblast from the hypopigmented area, and in 18% of the fibroblasts from an unaffected area.Address reprint requests to