Diagnostic quiz: progressive depigmentation
A 23-year-old woman with Fitzpatrick Skin Type 3 presents with patches of depigmentation around her hairline, left and right temples, and lips. The patient first noticed small, depigmented spots forming on her hands, elbows, knees, feet, and shins around 12 months ago, but the spots became noticeably worse after a recent vacation at the beach. After extensive sun exposure, larger patches of pigment loss with dark edges formed in visible areas. The patient doesn’t often use sunscreen and says she didn’t think she needed to with her darker skin tone.
The patient is generally in good health. Her mother has rheumatoid arthritis (RA), and RA runs in the family, but the patient has never been diagnosed with RA. The patient reports being psychologically impacted by the loss of pigmentation. She is often self-conscious or embarrassed when in public and says the condition significantly disrupts her daily life.