Hypopigmented Patches in a Child

Case presentationA 7-year-old boy is being evaluated for asymptomatic white spots of 2 years' duration. He has no triggers or preceding skin lesions. He denies any medication use or current medical issues. His medical history is significant for atopic dermatitis in infancy. Review of systems has negative findings.Physical examination reveals hypopigmented macules and patches on the trunk, extremities, buttocks, and genital region, affecting 20% of body surface area (Fig 1). No lymphadenopathy is noted. The lesions are not accentuated with a Wood lamp. Results of a complete blood cell count and comprehensive metabolic panel are within normal limits. A skin biopsy specimen from a hypopigmented macule on the posterior left thigh shows the following findings on H&E (Fig 2) and CD8 immunohistochemistry staining (Fig 3).Figure 2By Fabiana Lopes, MD; Courtney Haller, MD; Brett Keeling, MD; Lucia Z. Diaz, MD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3By Fabiana Lopes, MD; Courtney Haller, MD; Brett Keeling, MD; Lucia Z. Diaz, MD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Question #1: What is the most likely diagnosis?A.Hypopigmented mycosis fungoides (MF)B.Pityriasis albaC.VitiligoD.Postinflammatory hypopigmentationE.Pityriasis versicolorClick here to view disclosures, take the quiz, and claim CME credit. Case presentationA 7-year-old boy is being evaluated for asymptomatic white spots of 2 years' duration. He has no triggers or preceding skin lesions. He denies any medication use or current medical issues. His medical history is significant for atopic dermatitis in infancy. Review of systems has negative findings.Physical examination reveals hypopigmented macules and patches on the trunk, extremities, buttocks, and genital region, affecting 20% of body surface area (Fig 1). No lymphadenopathy is noted. The lesions are not accentuated with a Wood lamp. Results of a complete blood cell count and comprehensive metabolic panel are within normal limits. A skin biopsy specimen from a hypopigmented macule on the posterior left thigh shows the following findings on H&E (Fig 2) and CD8 immunohistochemistry staining (Fig 3).Figure 3By Fabiana Lopes, MD; Courtney Haller, MD; Brett Keeling, MD; Lucia Z. Diaz, MD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Question #1: What is the most likely diagnosis?A.Hypopigmented mycosis fungoides (MF)B.Pityriasis albaC.VitiligoD.Postinflammatory hypopigmentationE.Pityriasis versicolorClick here to view disclosures, take the quiz, and claim CME credit. A 7-year-old boy is being evaluated for asymptomatic white spots of 2 years' duration. He has no triggers or preceding skin lesions. He denies any medication use or current medical issues. His medical history is significant for atopic dermatitis in infancy. Review of systems has negative findings. Physical examination reveals hypopigmented macules and patches on the trunk, extremities, buttocks, and genital region, affecting 20% of body surface area (Fig 1). No lymphadenopathy is noted. The lesions are not accentuated with a Wood lamp. Results of a complete blood cell count and comprehensive metabolic panel are within normal limits. A skin biopsy specimen from a hypopigmented macule on the posterior left thigh shows the following findings on H&E (Fig 2) and CD8 immunohistochemistry staining (Fig 3). Question #1: What is the most likely diagnosis?A.Hypopigmented mycosis fungoides (MF)B.Pityriasis albaC.VitiligoD.Postinflammatory hypopigmentationE.Pityriasis versicolor Click here to view disclosures, take the quiz, and claim CME credit. The authors have no conflicts of interest to declare. Consent for the publication of recognizable photographs was provided by the authors at the time of article submission to the journal stating that all patients gave consent for their photographs to be published in print and online and with the understanding that these photographs may be publicly available.