A 27-Year-Old Woman With White Spots on Her Face

Miriam Kinai, MB ChB

Disclosures

September 14, 2018

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 27-year-old African-American woman presents with a history of white spots on her face for the past 2 months (see Figure 1).

Figure 1.

She reports that she has been applying concealer to cover the lesions as they have been progressively increasing in number and size. She states that the patches are neither painful nor itchy, but they have caused her considerable emotional stress as her livelihood depends upon her appearance. She admits dying her hair, which has begun to turn gray. The patient also reports having a flawless complexion prior to the development of these lesions and enjoying good health since childhood. She has not applied any prescription or over-the-counter medications to the lesions. The patient denies using any skin lightening products or undergoing any cosmetic procedures, such as microdermabrasion or laser skin resurfacing, in the past 6 months.

She has no family history of any similar skin diseases, hypertension, asthma, or any other significant illnesses. She has no known allergies and is not taking any medications. She is single and has no children. The patient denies drinking alcohol, smoking cigarettes, or using illicit drugs.

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