Ch 66

Vitiligo ve Hipopigmentasyon Bozuklukları

Vol 1 · sayfa 1098 · §10

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Fig. 66.2 Genital vitiligo. Complete loss of pigment on the penis and scrotum. Note the lack of any secondary changes. Courtesy Lorenzo Cerroni, MD.

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Fig. 66.3 Vitiligo. Depigmentation of the volar wrists as well as the palmar surfaces. Courtesy Jean L. Bolognia, MD.

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Fig. 66.5 Segmental vitiligo. Unilateral band of depigmentation on the face, the most common location for segmental vitiligo. Note the pigmented and depig- mented hairs within the affected area. Courtesy Kalman Watsky, MD.

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Fig. 66.6 Segmental vitiligo. Under normal light, vitiligo can be subtle in lightly pigmented individuals. The clue to the diagnosis is the poliosis of the eyelashes. Courtesy Jean L. Bolognia, MD.

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Fig. 66.7 Inflammatory vitiligo. An erythem- atous inflammatory border is evident. Such lesions are sometimes misdiagnosed as tinea corporis.

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Fig. 66.7 Inflammatory vitiligo. An erythem- atous inflammatory border is evident. Such lesions are sometimes misdiagnosed as tinea corporis.

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Fig. 66.9 Perifollicular repigmentation. Vitiligo on the elbow (A) and segmental vitiligo on the back (B) responding to PUVA and narrowband UVB therapy, respectively, with repigmentation in a prominent perifollicular pattern as well as from the periphery. The areas of repigmentation are darker in color than the uninvolved skin in (A) and have two shades (darker where well established and lighter at the expanding edge) in (B). A, Courtesy Jean L. Bolognia, MD; B, Courtesy Julie V. Schaffer, MD.

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Fig. 66.9 Perifollicular repigmentation. Vitiligo on the elbow (A) and segmental vitiligo on the back (B) responding to PUVA and narrowband UVB therapy, respectively, with repigmentation in a prominent perifollicular pattern as well as from the periphery. The areas of repigmentation are darker in color than the uninvolved skin in (A) and have two shades (darker where well established and lighter at the expanding edge) in (B). A, Courtesy Jean L. Bolognia, MD; B, Courtesy Julie V. Schaffer, MD.

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Fig. 66.10 Oculocutaneous albinism type 2 (OCA2). African patient with obvious squamous cell carcinomas on the cheek as well as multiple pigmented lentigines. Courtesy James Nordlund, MD.

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Fig. 66.11 Oculocutaneous albinism type 2 (OCA2). African patient with hypopigmented hair and large pigmented lentigines. Courtesy James Nordlund, MD.

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Fig. 66.13 Piebaldism. White forelock and characteristic triangular amelanotic patch on the mid-forehead. Courtesy Julie V. Schaffer, MD.

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Fig. 66.14 Piebaldism. Characteristic involvement of the mid extremities. Note the normally pigmented and hyperpigmented macules within the leukoderma. Courtesy Julie V. Schaffer, MD.

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Fig. 66.15 Waardenburg syndrome type 2. Heterochromia irides in the absence of dystopia canthorum. The white forelock is seen in the upper left corner. Courtesy Daniel Albert, MD.

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Fig. 66.16 Linear nevoid hypopigmentation. Hypopigmented streaks with various widths along the lines of Blaschko on the posterior lower extremities. Courtesy Antonio Torrelo, MD.

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Fig. 66.17 Nevus depigmentosus. Hypomelanotic patch with a decrease, but not absence, of pigmentation.

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Fig. 66.19 Postinflammatory hypopig- mentation. Hypopigmentation secondary to psoriasis (A), seborrheic dermatitis in an infant (B), pityriasis lichenoides chronica (C, D), and lichen striatus (E). Note the subtle flat-topped papules in the latter. Complete pigment loss in patients with severe atopic dermatitis (F), neonatal lupus erythema- tosus (G), and discoid lupus erythema- tosus (H). B, Courtesy Jean L. Bolognia, MD; E, G, Courtesy Julie V. Schaffer, MD.

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Fig. 66.19 Postinflammatory hypopig- mentation. Hypopigmentation secondary to psoriasis (A), seborrheic dermatitis in an infant (B), pityriasis lichenoides chronica (C, D), and lichen striatus (E). Note the subtle flat-topped papules in the latter. Complete pigment loss in patients with severe atopic dermatitis (F), neonatal lupus erythema- tosus (G), and discoid lupus erythema- tosus (H). B, Courtesy Jean L. Bolognia, MD; E, G, Courtesy Julie V. Schaffer, MD.

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Fig. 66.19 Postinflammatory hypopig- mentation. Hypopigmentation secondary to psoriasis (A), seborrheic dermatitis in an infant (B), pityriasis lichenoides chronica (C, D), and lichen striatus (E). Note the subtle flat-topped papules in the latter. Complete pigment loss in patients with severe atopic dermatitis (F), neonatal lupus erythema- tosus (G), and discoid lupus erythema- tosus (H). B, Courtesy Jean L. Bolognia, MD; E, G, Courtesy Julie V. Schaffer, MD.

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Fig. 66.20 Hypopigmented mycosis fungoides. A Variant with an admixture of classic erythematous lesions and hypopigmented patches with scale on the legs in an adolescent. B Purely hypopigmented lesions of variable sizes on the back and buttocks of a child. A, Courtesy Edward Cowen, MD; B, Courtesy Julie V. Schaffer, MD.

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Fig. 66.20 Hypopigmented mycosis fungoides. A Variant with an admixture of classic erythematous lesions and hypopigmented patches with scale on the legs in an adolescent. B Purely hypopigmented lesions of variable sizes on the back and buttocks of a child. A, Courtesy Edward Cowen, MD; B, Courtesy Julie V. Schaffer, MD.

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Fig. 66.21 Leukoderma of systemic sclerosis (scleroderma). Uniform retention of perifollicular pigment within areas of leukoderma. Hyperpigmentation is also seen overlying a superficial vein.

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Fig. 66.22 Guttate lichen sclerosus involving the areola.

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Fig. 66.23 Tinea versicolor. A Hypopigmented variant with obvious scale. B Guttate hypopigmented lesions on the lateral cheek of a child; note the classic scaly lesions in the posterior auricular area. B, Courtesy Julie V. Schaffer, MD.

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Fig. 66.23 Tinea versicolor. A Hypopigmented variant with obvious scale. B Guttate hypopigmented lesions on the lateral cheek of a child; note the classic scaly lesions in the posterior auricular area. B, Courtesy Julie V. Schaffer, MD.

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Fig. 66.24 Tuberculoid leprosy. Large, thin hypopigmented plaque on the elbow with a raised light pink border.

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Fig. 66.25 Onchocerciasis (leopard skin). Depigmentation of the shin with follicular repigmentation or retention of perifollicular pigment, a common site for the associated leukoderma.

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Fig. 66.27 Vitiligo-like leukoderma associated with anti-cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) therapy for metastatic melanoma. Courtesy Jean L. Bolognia, MD.

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Fig. 66.28 Hypopigmentation due to injection of corticosteroids into the anatomic snuff box. The outline is both stellate and linear.

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Fig. 66.28 Hypopigmentation due to injection of corticosteroids into the anatomic snuff box. The outline is both stellate and linear.

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Fig. 66.30 Idiopathic guttate hypomelanosis. A Typical 1–5 mm macules on the shin. B Occasionally there is admixture of larger lesions.

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Fig. 66.30 Idiopathic guttate hypomelanosis. A Typical 1–5 mm macules on the shin. B Occasionally there is admixture of larger lesions.

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Fig. 66.30 Idiopathic guttate hypomelanosis. A Typical 1–5 mm macules on the shin. B Occasionally there is admixture of larger lesions.

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Fig. 66.31 Guttate leukoderma. A Disseminated hypopigmented keratoses presenting as >200 guttate, minimally elevated hypopigmented papules. The lesions developed after several months of PUVA therapy. Histologically, there was no evidence of verruca plana. B Clear cell papulosis presenting as multiple hypopig- mented, barely elevated, small flat-topped papules and macules in the suprapubic area and on the abdomen along the “milk lines” in a 2-year-old boy. Histologically, these lesions are characterized by large clear cells in the lower epidermis that have a pattern of immunohistochemical staining similar to clear cells of Toker and extra- mammary Paget disease. C Guttate hypopigmentation in sun-exposed areas on the extensor aspect of the arm in a 3-year-old Hispanic boy with xeroderma pigmen- tosum. Note the sparing of the proximal upper arm, which is normally covered by a T-shirt. A, Courtesy Jean L. Bolognia, MD; B, C, Courtesy Julie V. Schaffer, MD.

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Fig. 66.31 Guttate leukoderma. A Disseminated hypopigmented keratoses presenting as >200 guttate, minimally elevated hypopigmented papules. The lesions developed after several months of PUVA therapy. Histologically, there was no evidence of verruca plana. B Clear cell papulosis presenting as multiple hypopig- mented, barely elevated, small flat-topped papules and macules in the suprapubic area and on the abdomen along the “milk lines” in a 2-year-old boy. Histologically, these lesions are characterized by large clear cells in the lower epidermis that have a pattern of immunohistochemical staining similar to clear cells of Toker and extra- mammary Paget disease. C Guttate hypopigmentation in sun-exposed areas on the extensor aspect of the arm in a 3-year-old Hispanic boy with xeroderma pigmen- tosum. Note the sparing of the proximal upper arm, which is normally covered by a T-shirt. A, Courtesy Jean L. Bolognia, MD; B, C, Courtesy Julie V. Schaffer, MD.

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Fig. 66.32 Progressive macular hypomelanosis. Note the coalescence of the non-scaly hypopig- mented macules on the center of the back.

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