Snapshot A 45-year-old woman presents to her dermatologist for further management of her vitiligo. In the past few months she has been very stressed with trouble at work, home, and recent deaths in the family. Her vitiligo has spread from her hands to her arms, face, chest, back, and legs. Given the widespread nature of her disease, she is started on phototherapy with pulses of oral steroids. Introduction Clinical definition autoimmune disease characterized by absent pigmentation due to loss of functioning melanocytes Epidemiology demographics onset between 10-30 years of age risk factors family history of vitiligo Pathogenesis exact mechanism is unknown theories include autoimmune attack on melanocytes stress leading to neurogenic factors that affect melanocyte survival reactive oxygen species attack on melanocytes Associated conditions vitamin D deficiency thyroid disease alopecia areata Prognosis chronic disease that waxes and wanes Presentation Symptoms asymptomatic Physical exam depigmented patches (not just lack of a tan or hypopigmentation) sharply demarcated white lesions Wood lamp can highlight these areas fluorescence Studies Biopsy rarely needed only done when clinical diagnosis is unclear Histology absence of melanocytes on tissue slide loss of epidermal pigmentation Differential Tinea versicolor Pityriasis alba Treatment Conservative cosmetic camouflage indication for patients who wish to camouflage the vitiligo patches modalities temporary makeup to color skin tattoo bleaching skin to produce uniform color sunscreen indication to protect against sunlight Medical topical corticosteroids indication for localized disease topical calcineurin inhibitors indication for localized disease phototherapy indications for widespread disease used often with topical vitamin D analogs or oral corticosteroids modalities narrowband ultraviolet B psoralen with ultraviolet A oral corticosteroids indication used either alone or with phototherapy Complications Poor quality of life and psychologic burden
QUESTIONS 1 of 3 1 2 3 Previous Next (M2.DM.17.4799) A 22-year-old woman arrives to your clinic complaining of a worsening rash. She reports the rash first appeared one year ago on her hands, but she had been too stressed with her final semester of classes to see a dermatologist. Since she first noticed it, the lesion has increased in size. The patient denies pain or pruritis, but notes that sometimes her hands are dry. Her past medical history is significant for seasonal allergies. Her current medications include only an oral contraceptive. Her family history is significant for a cousin with systemic lupus erythematous. She works part-time as a hair-dresser, which she started 6 months ago. She denies tobacco use, but has 3-4 glasses of wine on the weekend. Figure A shows a photograph of the patient’s hand. On physical exam you also note well-demarcated, de-pigmented patches in her armpits and a similar patch on her chest. Which of the following may be associated with this patient’s condition? QID: 109181 FIGURES: A Type & Select Correct Answer 1 Glossitis 50% (5/10) 2 Dorsocervical fat pad 10% (1/10) 3 Exposure to para-phenylene diamine 20% (2/10) 4 Post-exertional wheezing 10% (1/10) 5 White forelock (poliosis) 10% (1/10) M 6 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept (M2.DM.16.4694) An 8-year old boy is brought to the pediatrician by his distraught mother who is concerned about "light spots" that first appeared 4 months ago and have been slowly expanding over different parts of his body. He is not bothered by these areas, and they do not itch, burn, or bleed. He has otherwise been well. There is no family history of this skin condition, though his mother has a history of hypothyroidism. His skin exam is notable for smooth, hypopigmented patches over his bilateral knuckles, knees, and inner thighs, as seen in Figure A. His exam is also notable for a tuft of leukotrichia over his occiput, as seen in Figure B. Which of the following will help to confirm the diagnosis? QID: 107863 FIGURES: A B Type & Select Correct Answer 1 Derum anti-Rho autoantibodies 100% (2/2) 2 Punch biopsy 0% (0/2) 3 Examination under Wood lamp 0% (0/2) 4 Darier's scratch test 0% (0/2) 5 Tzanck smear 0% (0/2) M 6 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept (M2.DM.15.31) An African American teenage boy presents for evaluation of skin discoloration shown in Figure A. He reports that the discoloration had grown more noticeable over time and that it seems to get worse with prolonged sun exposure. He notes a similar pattern of discoloration in his left hand and reports that his mother has a similar appearing lesion on her skin. What is the cause of the skin discoloration in this patient? QID: 104242 FIGURES: A Type & Select Correct Answer 1 Tinea versicolor 3% (1/29) 2 Destruction of melanocytes 90% (26/29) 3 Postinflammatory hypopigmentation 3% (1/29) 4 Impaired wound healing 0% (0/29) 5 Post-surgical scarring 0% (0/29) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept