subsequent degranulation of mast cells with release of histamine and other mediators When large amounts of these mediators are released, generalized flushing, persistent diarrhea, or hypotension may ensue Children with these symptoms require therapy directed against histamine and prostaglandin D2 Long-acting H1 blockers like cetirizine are often combined with long-acting H2 blockers like ranitidine Shorter-acting H1 blockers, such as diphenhydramine and hydroxyzine, are sometimes used as rescue agents Caution needs to be used with medications that potentially degranulate mast cells, such as opioids, NSAIDs and anesthetics, as well as avoidance of physical stimuli Children who suffer from persistent histamine-induced diarrhea may benefit from the addition of oral cromolyn sodium Over time, the condition can improve although it may not completely resolve before adolescence Hypopigmentation/Depigmentation In the neonatal period, skin findings characterized but loss of pigment are most likely related to pigment patterning in development Pigmentary mosaicism exists when an individual is composed of two or more genetically different cell populations that lead to color variation With pigmentary mosaicism, both hypoand hyperpigmentation can occur within a Blaschkoid distribution While small areas require reassurance, larger areas can be associated with neurologic, eye, cardiac, and skeletal anomalies No definitive therapy exists