Vitiligo

QUESTION 45

A 37-year-old man presents to the dermatology clinic for evaluation of spreading pigmentation changes. He reports an 8-month history of progressive lightening of the skin on the hands as well as the face, around the nose and mouth. He denies any history of contact with chemicals or a history of burns. He has no other medical conditions and family history is notable for autoimmune thyroid disease in his mother and type I diabetes in his brother. On examination, there are confluent patches of depigmentation overlying the dorsal hands and wrists with no underlying erythema (45). Examination of the skin under Woods lamp demonstrates enhancement of the depigmented patches with white-blue fluorescence.