April 2005

Fig.1

Fig.2

HPI: 22 year old white female presented with a history of hypopigmented patches on the trunk and extremities for 4 years. Of note, the patient also occasionally reports pink scaly papules near those affected areas.The patient first sought treatment at a dermatology clinic at an outside institution 2 years ago. A KOH preparation was done at the time and it was read as negative. The patient was treated with triamcinolone acetonide 0.1% ointment. The lesions resolved but recurred several months later. A biopsy was performed approximately one year ago from the center of a hypopigemented patch and it was compared with a biopsy of the normal skin at the time. The report stated that no significant decrease of melanocyte numbers was appreciated and evidence of mycosis fungoides was not seen.
The patient then presented to Washington University for evaluation five months ago. The hypopigmented patches were attenuated by a summer tan and the patient was told to return for a skin biopsy when the hypopigmented patches were more evident. Upon return, the hypopigmented patches have become more apparent and more progressive (Figure 1 and 2 show hypopigmented patches without scaling or follicular accentuation).

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