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Patient Case: Patchy Hypopigmentation (Vitiligo)

Patient Case: Patchy Hypopigmentation (Vitiligo)

Discussion

A 32-year-old woman presents to a dermatology clinic with progressive light patches on her skin over the past two years. She first noticed the spots on her hands and face, and they have gradually spread to her elbows and knees. The affected areas are sharply demarcated, completely depigmented, and asymptomatic, with no associated redness, scaling, or itching.

Her medical history is unremarkable, and she is otherwise healthy. There is no family history of similar skin changes. A Wood’s lamp examination accentuates the lesions, making them more prominent. A skin biopsy is performed, revealing loss of melanocytes in the affected areas, confirming a diagnosis of vitiligo.

She is counseled on the chronic nature of vitiligo, available treatment options including topical corticosteroids, calcineurin inhibitors, and phototherapy, and the importance of sun protection to prevent contrast between affected and unaffected skin.

Questions
  1. What is the most likely diagnosis in this patient?
    a) Tinea versicolor
    b) Vitiligo
    c) Pityriasis alba
    d) Albinism
  2. What is the underlying cause of this condition?
    a) Autoimmune destruction of melanocytes
    b) Fungal infection affecting pigmentation
    c) Genetic mutation affecting melanin synthesis
    d) Chronic sun exposure
  3. Which of the following is the most useful examination tool for confirming this diagnosis?
    a) Patch testing
    b) Wood’s lamp examination
    c) Skin scraping and KOH test
    d) Dermatoscopy
  4. What is the first-line treatment for this condition?
    a) Antifungal therapy
    b) Topical corticosteroids or calcineurin inhibitors
    c) Systemic antibiotics
    d) Chemotherapy
Reveal answers

Answers

  1. (b) Vitiligo
    • The presence of sharply demarcated, completely depigmented patches on sun-exposed areas without scaling or itching strongly suggests vitiligo, an autoimmune condition causing melanocyte destruction.
  2. (a) Autoimmune destruction of melanocytes
    • Vitiligo is caused by autoimmune-mediated melanocyte loss, leading to patchy depigmentation of the skin. It is not due to infections or sun exposure.
  3. (b) Wood’s lamp examination
    • Under Wood’s lamp (UV light), vitiligo lesions appear more prominent, helping differentiate it from other causes of hypopigmentation such as pityriasis alba or tinea versicolor.
  4. (b) Topical corticosteroids or calcineurin inhibitors
    • First-line treatment includes topical corticosteroids (for active disease) and calcineurin inhibitors (for sensitive areas like the face). Phototherapy is another effective option for widespread vitiligo.