A 22-year-old woman comes to the office due to a skin disorder. The patient has a 5-year history of patchy depigmentation primarily affecting the hands, feet, and face. Some of her lesions have resolved, but overall she has experienced a slowly progressive course. The patient has no associated pain, itching, or erythema. Medical history is unremarkable, and her only regular medication is an oral contraceptive. Vital signs are normal. Physical examination findings are shown in the image below with similar lesions on the face and hands. Examination is otherwise normal. Which of the following diseases is most likely associated with this patient's skin condition?

Question

A 22-year-old woman comes to the office due to a skin disorder.  The patient has a 5-year history of patchy depigmentation primarily affecting the hands, feet, and face.  Some of her lesions have resolved, but overall she has experienced a slowly progressive course.  The patient has no associated pain, itching, or erythema.  Medical history is unremarkable, and her only regular medication is an oral contraceptive.  Vital signs are normal.  Physical examination findings are shown in the image below with similar lesions on the face and hands.  Examination is otherwise normal.  Which of the following diseases is most likely associated with this patient's skin condition?

Quizplus · Accepted Answer

11ec25c8_d395_32ab_bc81_8d8f57154cf8_MD0003_00 This patient has well-demarcated, depigmented macules involving the face and distal extremities consistent with vitiligo. Vitiligo is caused by regional destruction of melanocytes, most likely due to an autoimmune etiology. Genetic and environmental factors may also play a role. Vitiligo can occur as an isolated disorder but is often associated with other autoimmune conditions (eg, pernicious anemia, primary adrenal insufficiency, alopecia areata, rheumatoid arthritis, Sjogren syndrome). Autoimmune thyroid disease (eg, chronic lymphocytic [Hashimoto] thyroiditis, Graves disease) is especially common, and many experts advise patients with vitiligo be assessed for thyroid function. (Choice B) HIV infection increases the risk for tinea versicolor, which typically presents with hypopigmented macules. In contrast to vitiligo, which has completely depigmented lesions, the macules in tinea versicolor retain partial pigmentation. They also have a predilection for the chest and upper back rather than the face and distal extremities. tinea versicolor (Choices C and E) Hyperparathyroidism, gastrin-producing pancreatic tumors (Zollinger-Ellison syndrome), and pituitary tumors can occur together in the multiple endocrine neoplasia type 1 syndrome. This disorder is due to mutations in the MEN1 gene. It is not autoimmune and not associated with vitiligo. (Choice D) Type 1 diabetes mellitus is due to autoimmune destruction of pancreatic beta cells and is associated with vitiligo. Type 2 diabetes is not an autoimmune disorder and not associated with vitiligo. Educational objective: Vitiligo is an autoimmune condition characterized by areas of depigmentation due to destruction of melanocytes. It can be associated with other autoimmune conditions, such as pernicious anemia, autoimmune thyroid disease, type 1 diabetes mellitus, primary adrenal insufficiency, hypopituitarism, and alopecia areata. References: Positivity rates of antithyroid antibody, antinuclear antibody and thyroid peroxidase antibody in different types of vitiligo. (http://www.ncbi.nlm.nih.gov/pubmed/26452586)

A 22-Year-Old Woman Comes to the Office Due to a Skin