White spots
A 46-year-old woman asked her family physician (FP) about the white spots on her arms. She was in the office for her yearly well woman exam and mentioned that these white spots had been growing in number over the past year. She acknowledged that she was an avid tanner when she was younger.
What's your diagnosis?
The FP recognized these areas of hypopigmentation as idiopathic guttate hypomelanosis. The FP told the patient that she did not have cancer and described the condition as benign and neither contagious nor dangerous. Next, she explained that the word “idiopathic” was misleading, since ultraviolet damage to melanocytes from the sun was the likely cause.
The patient was happy with the explanation but wanted to know if she would continue to get new white spots. The FP told her that more white spots were a possibility, given that she’d spent a lot of time in the sun. The FP suggested that the patient be diligent about using sunscreen to prevent further sun damage.
A variety of treatments have been used with limited success to treat this condition, including topical steroids, topical retinoids, dermabrasion, and cryotherapy.
In this case, the patient decided not to pursue any treatment options.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Hughes K, Usatine R. Vitiligo. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:849-852.
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