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June 2008
By Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 47-year-old woman with a history of hypertension and hypothyroidism presents with progressive, symmetrical loss of pigment involving her hands, axillae, shoulders, and groin. She first began to notice the changes several months ago. The affected areas are asymptomatic but highly susceptible to sunburn.
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This patient has vitiligo, an acquired autoimmune disorder of pigmentation. Depigmented patches are typically symmetrical and occur most commonly on the face, chest, hands, axillae, and groin. The hair in these areas may also turn white. The disorder occurs in up to 1% of the population and often appears before age 20. Family history is positive for vitiligo in 30% of cases. Treatment options include ultrapotent topical steroids, tacrolimus, phototherapy, and skin grafting. Patients should be advised to avoid exposing affected areas to sunlight and to use sunscreen during outdoor activities.
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Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 40(6):43-44, 2008
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