Thursday, June 16, 2016

Hypopigmentation in an African

The patient is a 39 yo man from Ghana.  His wife noticed these spots on his back recently.  My first diagnosis was tinea versicolor; but KOH prep showed only spores.  Is this just quiescent T.v.?  It's symmetrically distributed over upper back (no where else).  In differential diagnosis was vitiligo -- but this is incomplete hypopigmentyation (which can occur with vitiligo, but less commonly).  I suggested ketoconazole cream and a follow-up in 3 months.  If still present, may do a biopsy.
What are your thoughts?

1. The utility of dermoscopy in the diagnosis of evolving lesions of vitiligo.
Thatte SS1, Khopkar US.  Indian J Dermatol Venereol Leprol. 2014 Nov-Dec;80(6):505-8.
BACKGROURD: Early lesions of vitiligo can be confused with various other causes of hypopigmentation and depigmentation. Few workers have utilized dermoscopy for the diagnosis of evolving lesions of vitiligo.
CONCLUSION: Pigmentary network changes, and perifollicular and perilesional hyperpigmentation on polarized light examination, and a diffuse white glow on ultraviolet light examination were noted in evolving vitiligo lesions. Histopathological examination was comparatively less reliable. Dermoscopy appears to be better than routine histopathology in the diagnosis of evolving lesions of vitiligo and can obviate the need for a skin biopsy. Free Full Text.

2. Dermoscopy as an ancillary tool for the diagnosis of pityriasis versicolor.
Zhou H, Tang XH, Chen MK. J Am Acad Dermatol. 2015 Dec;73(6):e205-6. (this is only reference in PubMed on T.v. and dermsocopy and it is not particularly helpful)

3. Dermatoscope--the dermatologist's stethoscope.
Lallas A, Argenziano G.  Indian J Dermatol Venereol Leprol. 2014 Nov-Dec;80(6):493-4. Full Free Text 
This is an interesting somewhat philosophical article.  The references are extensive and helpful.


  1. Very interesting .. Maybe diflucan 200 mg daily for 3 days or 2 pills weekly would clear him.
    Also vitamin d

  2. from K. Sharquie, Baghdad: This is T.v. of hypopigmented type.The color takes long time to go. Use iodine tincture and the color will return more quickly.

  3. from A. Lallas, Greece: "Concerning the case, unfortunately we do not still know enough on this differential diagnosis. For example, there is almost no data at all on how pityriasis versicolor looks like dermoscopically. From some personal observations, I think that some scaling is often evident and the color is not usually ivory-white, but rather hypo pigmented.

    In conclusion, If I would have to choose between the 2, this aspect fits better with vitiligo. Of course, I repeat, we do not still have data enough allowing to base too much on Dermoscopy."


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