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Patient Case: Disorders of Pigmentation (Hyperpigmentation and hypopigmentation)

Patient Case: Disorders of Pigmentation (Hyperpigmentation and hypopigmentation)

Discussion

A 35-year-old woman presents to a dermatology clinic with concerns about patchy skin discoloration on her face and arms. She reports that over the past six months, she has noticed dark patches on her cheeks and forehead, which became more noticeable after sun exposure. She also has lighter, depigmented patches on her forearms, which appeared around the same time.

Her medical history is significant for mild eczema in childhood, but she has no history of autoimmune diseases. She does not take any chronic medications, except for oral contraceptive pills started a year ago.

On examination, the hyperpigmented areas are irregularly shaped, brown patches on the cheeks, forehead, and upper lip, while the hypopigmented areas appear as well-defined, lighter patches on her forearms, with no associated scaling or itching. A Wood’s lamp examination highlights the hyperpigmented areas more prominently.

Based on the clinical findings, she is diagnosed with melasma (hyperpigmentation) and post-inflammatory hypopigmentation due to prior eczema. She is advised to use broad-spectrum sunscreen, topical hydroquinone for melasma, and gentle moisturizers for the hypopigmented areas to aid natural repigmentation.

Questions
  1. What is the most likely cause of the patient’s facial hyperpigmentation?
    a) Vitiligo
    b) Melasma
    c) Tinea versicolor
    d) post-inflammatory hyperpigmentation
  2. Which factor is most likely contributing to the patient’s melasma?
    a) Fungal infection
    b) Oral contraceptive use and sun exposure
    c) Iron deficiency anemia
    d) Bacterial skin infection
  3. What is the best initial treatment for melasma in this patient?
    a) Broad-spectrum sunscreen and topical hydroquinone
    b) Oral corticosteroids
    c) Antifungal medication
    d) Laser therapy
  4. What is the most likely cause of the hypopigmented patches on the patient’s forearms?
    a) Tinea versicolor
    b) Post-inflammatory hypopigmentation
    c) Albinism
    d) Pityriasis alba
Reveal answers

Answers

  1. (b) Melasma
    • The brown, irregular patches on sun-exposed areas suggest melasma, a common pigmentation disorder triggered by hormonal factors and UV exposure.
  2. (b) Oral contraceptive use and sun exposure
    • Melasma is often linked to hormonal changes (e.g., pregnancy, birth control pills) and worsened by sun exposure, making sunscreen a crucial part of treatment.
  3. (a) Broad-spectrum sunscreen and topical hydroquinone
    • Sunscreen prevents worsening of hyperpigmentation, and hydroquinone is a first-line depigmenting agent that lightens melasma over time.
  4. (b) Post-inflammatory hypopigmentation
    • The lighter patches on the forearms with a history of eczema suggest post-inflammatory hypopigmentation, a temporary loss of melanin following skin inflammation.