A 22-year-old woman comes to the physician with several depigmented skin lesions on her hands and feet. She has no other physical complaints. Her past medical problems include migraine headaches, for which she takes naproxen as needed. She is married and has an 8-month-old child.
Vital signs are within normal limits. Skin examination findings are shown below.
Which of the following is the most appropriate next step in management of this patient?

Question

A 22-year-old woman comes to the physician with several depigmented skin lesions on her hands and feet.  She has no other physical complaints.  Her past medical problems include migraine headaches, for which she takes naproxen as needed.  She is married and has an 8-month-old child.
Vital signs are within normal limits.  Skin examination findings are shown below.
Which of the following is the most appropriate next step in management of this patient?

Quizplus · Accepted Answer

Vitiligo is an acquired skin depigmentation (localized or generalized) likely due to a progressive autoimmune destruction of melanocytes. Patients usually present by age 20-30 with well-demarcated and depigmented lesions. Diagnosis is primarily clinical. Vitiligo is frequently associated with other autoimmune diseases (eg, autoimmune thyroid disease, type I diabetes). Studies indicate a higher incidence of autoimmune thyroid disease in vitiligo (up to 20% of patients) compared to non-vitiligo patients. The vitiligo usually precedes the onset of thyroid disease. As a result, most guidelines recommend screening vitiligo patients for autoimmune thyroid disease and type I diabetes. Treatment involves repigmentation with topical corticosteroids (preferred), topical calcineurin inhibitors, or ultraviolet light. (Choices A and B) All other autoimmune conditions (eg, pernicious anemia, systemic lupus erythematosus) are less common and require screening (eg, antinuclear antibodies, complete blood count) only in patients with suggestive symptoms, family history, or examination findings. (Choice C) Intralesional corticosteroid injections are the preferred treatment for alopecia areata, which typically presents with isolated patches of hair loss. Although it can be associated with vitiligo, alopecia areata does not directly cause loss of skin pigmentation. (Choice D) Skin biopsy is required only in atypical cases to differentiate vitiligo from other disorders. Educational objective: Vitiligo is an autoimmune skin disease causing partial or complete loss of melanocytes in affected skin. It presents as depigmented patches and is associated most frequently with thyroid disorders and type I diabetes. __________ References: Skin findings in thyroid diseases. (http://www.ncbi.nlm.nih.gov/pubmed/19327604) The prevalence of thyroid disease in patients with vitiligo: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/22860695) Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. (http://www.ncbi.nlm.nih.gov/pubmed/21839315) Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families. (http://www.ncbi.nlm.nih.gov/pubmed/12753387)

A 22-Year-Old Woman Comes to the Physician with Several Depigmented