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Case 341

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A 52-year-old male patient sought specialized outpatient care complaining of "clear spots" in the face region, which was progressive, with an increase in lesion size, about 2 months ago. He has no comorbidities. At the physical examination, hypochromic spots, sometimes pinkish, of varying size on the face and hypochromic spot associated with leukotriquia in the axillary region, not previously observed by the patient, are evident. Lesions do not show scaling or altered sensitivity.

Based on the clinical history and images presented, which diagnosis is most likely?

a) Pityriasis versicolor

25%

b) Vitiligo

25%

c) Seborrheic dermatitis

25%

d) Inderteminate leprosy

25%
   

Highlights

- Vitiligo is characterized by achromic and asymptomatic macules, without clinical signs of inflammation;
- It also affects both sexes and any age with peak in the 2nd and 3rd decade of life;
- Its etiology is unknown, although there is an association with autoimmune diseases;
- The diagnosis is clinical, and Wood's light is used for differentiation of hypochromic and achromic macules;
- Phototherapy and immunomodulators are used to stabilize disease activity and repigmentation of achromic macules.

References

Azulay RD, Azulay DR. Dermatology 6. ed. Rio de Janeiro: Guanabara Koogan; 2015.

Roh MR, Oh SH. Acquired hypopigmentation disorders other than vitiligo [internet]. UpToDate; 2018. [Access on:: 15 out. 2018]. Available in: https://www.uptodate.com/contents/acquired-hypopigmentation-disorders-other-than-vitiligo

Grimes Pe. Vitiligo: Pathogenesis, clinical features, and diagnosis [internet]. UpToDate; 2017. [Access on: 15 out. 2018]. Available in: https://www.uptodate.com/contents/vitiligo-pathogenesis-clinical-features-and-diagnosis
Grimes Pe. Vitiligo: Management and prognosis [internet]. UpToDate; 2017. [Access on: 15 out. 2018]. Available in: https://www.uptodate.com/contents/vitiligo-management-and-prognosis

Authors:

Daniela Tereza Gonçalves Manso, 5th year medical student at UFMG
E-mail: danimanso.dm@gmail.com

Giovanni Oliveira Carvalho, 5th year medical student at UFMG

E-mail: gocarvalho91@gmail.com

Acknowledgments:

Renan Bernardes, resident of the 2nd year of dermatology, for assistance in the selection of photographs.

Supervisor

Dra. Vanessa Barreto Rocha, dermatologist, guest lecturer at the Discipline of Dermatology, Federal University of Minas Gerais.
E-mail: vanessabarreto@oi.com.br

Reviewers

Rafael Valério, Gabriel Santos, Vinícius Avelar, Elaine Iwayama

Translated By

Eduardo José Paolinelli Vaz de Oliveira, 6th year medical student at UFMG

Test question

(SURCE 2015) Patient attends for evaluation of white spots on the skin. There is no pain, itching or any other symptom. You notice hypopigmented lesions in the upper chest (Figure 1). These lesions take on a scaly appearance after traction of the local skin by the examiner (figure 2). Which are the most probable diagnostics?

 

a) Vitiligo

25%

b) Tinea corporis

25%

c) Lichen simplex chronicus

25%

d) Pityriasis versicolor

25%

e)

25%
   

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