Vitiligo
Presentation
- Altered pigmentation due to destruction of melanocytes.
- May affect any part of the body, including hair. Most commonly the hands, feet, forearms and face.
- Presents with well-demarcated white or pale round or oval patches, which may be localised or generalised. Skin itself appears normal.
- More obvious in dark-skinned patients or after a holiday when areas of skin fail to tan.
- May follow trauma such as sunburn or emotional stress.
- Often associated with auto-immune problems such as thyroid disease, pernicious anaemia or alopecia areata.
- Usually presents before the age of 30, commonly with a family history.
- Wood's light highlights depigmented areas.
Management
- Sunscreen to protect depigmented areas that burn rather than tan.
- Topical steroids. Calcineurin inhibitor on the face may help and cause less damage.
- Phototherapy - narrow band UVL or PUVA; or laser therapy.
- If repigmentation fails, depigmentation of normal skin with 20% monobenzylether of hydroquinone may make the vitiligo less obvious.
- Skin grafts occasionally used for small, persistent unchanging areas.
Tinea versicolor
Presentation
- Fungal infection of the skin caused by Malassezia furfur.
- Most common in teenagers and young adults.
- Presents with well demarcated, round or oval, white or reddish brown macules with a fine scale.
- Often first noticed when affected areas fail to tan.
- Most common on trunk, back, abdomen, upper arms and legs.
- Recurrences are common.
- Can confirm diagnosis with skin scraping for microscopy.
- Affected areas may fluoresce yellow-green under Wood's light.
Management
- Topical selenium sulphide; topical imidazole antifungal agent such as ketoconazole shampoo, clotrimazole or miconazole.
- If persistent or widespread, systemic triazole antifungal agent such as fluconazole.
- Commonly recurs, especially in the immunocompromised.
- Prophylactic treatment with ketoconazole or fluconazole for one to three days each month may prevent recurrences.
