INTRODUCTION
Various forms of skin hypopigmentation can occur spontaneously. When multiple forms of hypopigmentation occur simultaneously, the diagnoses may seem unclear. This article illustrates a patient who presented simultaneously with each of vitiligo, (idiopathic) guttate hypomelanosis (IGH), and a rarely noted hypopigmented variant of seborrhoeic keratosis. We outline distinguishing clinical features for clinicians to consider on encountering a patient with adult-acquired hypopigmentation. Subsequently, we present a useful approach to diagnosing common acquired forms of localised hypopigmentation seen in primary care.
CASE REPORT
A 61-year-old black female presented to her GP with white patches on her back (Figure 1a), and was diagnosed with vitiligo. Management included tacrolimus 0.1% ointment for daily use and referral to a dermatologist. She was also advised to avoid sun exposure to the affected areas. In the interim, the patient was exposed to ultraviolet radiation (UVR) while vacationing in Jamaica and noted improvement in the white patches. At her first dermatology visit, she displayed repigmenting patches of vitiligo with brown macules perifollicularly (Figure 1b). She queried whether new hypopigmented lesions were also vitiligo. Specifically, her back had light ‘stuck on’ papules and her arms and back had other 5-mm hypopigmented macules (Figure 1c and 1d). She queried why select back lesions improved after sun exposure despite being advised to avoid it. Her dermatologist explained that her initial back patches of vitiligo had repigmented due to UVR from …
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