Hypopigmentation + Vitiligo

Question 1

1. DDx hypopigmentation
2. DDx pigmentary dilution
3. DDx linear leukoderma (no mnemonic)

Answer 1

1. VIC GETS NIP
   V: vitiligo
   I: infection – leprosy, onchocerciasis, syphilis, pit versi, leishmaniasis
   C: chemical leukoderma – drugs (imatinib)
   G: genetic eg piebaldism, TS, pigmentary dilution list CAPN M GOH
   E: eating – nutrition: Kwashiorkor, copper, selenium
   T: tinea versicolour
   S: syphilis, scleroderma
   N: naevus depigmentosus
   I: idiopathic guttate hypomelanosis
   P: post inflammatory, MF
2. CAPN M GOH (Captain Michelle Goh)
   Chediak Higashi
   Apert syndrome
   Phenylketonuria
   Nutritional - copper, selenium deficiency
   Menke’s
   Griscelli - pigmentary dilution, neurologic impairment, immunodeficiency
   Oculocutaneous albinism
   Hermansky Pudlak
3. Linear naevoid hypopigmentation, lichenstriatus, vitiligo, IP, PIHypo, Goltz, CHH, epidermal naevus, linear LS, pigmentary demarcation lines

Question 2

Vitiligo
1. Classification
2. History ( see BJD notes)
3. Examination findings
4. Associations, how Ix for them
5. Mgmt options
6. Syndromic

Answer 2

1. Segmental vs NSV (vitiligo). See notes
2. site, type, extent, stability, speed of onset, age onset, triggers, QOL, psychological and psychosocial impact. Personal or FHx of associated thyroid dysfunction, other AI disease. Type and duration previous Rx
3. See notes
4. TADA CARL
5. see notes
6. Vogt Koyanagi Harada. Uveitis, aseptic meningitis
   Alezzandrini. Unilateral scalp, face. Visual changes

Question 3

Waardenburg
1. Inheritance
2. Key clinical features

Answer 3

1. AD > AR
2. Achromia skin, hair - same pattern as piebaldism up to 60%
   Congenital deafness up to 35%
   Synophrys
   Broad nasal root

Question 4

Piebaldism
1. Inheritance
2. Gene
3. Clinical features
4. Associations

Answer 4

1. AD
2. KIT
3. Poliosis
   Leukoderma patches mid forehead, limbs, trunk. Normally and hyperpigmented patches within depigmented areas
4. NONE. Need to do hearing check to exclude Waardenburg

Question 5

Hereditary hypomelanosis
1. OCA
- what
- inheritance
- ocular features
2. Hermansky Pudlak - 3 facts
3. Chediak Higashi. 4 facts
4. PKU. 4 facts
5. Menke’s. 4 facts
6. Apert syndrome. 4 facts

Answer 5

1. OCA. Absence of melanin pigment. Normal melanocytes.
   7 types.
   AR.
   Strabismus, nystagmus, lack binocular vision
2. PIgmentary dilution. Bleeding tendency. IPF.
3. Pigmentary dilution. Bleeding tendency. Immunodeficiency. Progressive neurologic dysfunction
4. Inborn error metabolism. pigmentary dilution. Mousy smell. Atopic like dermatitis
5. Menke. Blaschkoid hypopigmentation. XLR copper metabolism. Alopecia from abnormal hair shafts. Neurologic abnormalities
6. Apert. Pigmentary dilution. Seborrhoea, acne. Synostoses. Hyperhidrosis.

Question 6

Progressive macular hypopigmentation
1. Who gets it
2. What does it look like?
3. Pathogenesis. Wood’s

Answer 6

1. Typically young women, tropics
2. Poorly defined hypopigmented macules, patches trunk, Non scaly
3. C acnes. Pink/red fluorescence

Question 7

Naevus anaemicus
1. Wood’s lamp
2. What is it
3. Can be seen in. (2 syndromes)
4. Diascopy

Answer 7

1. Becomes inapparent. Helps to differentiate from hypomelanotic macules
2. Congenital pale area of skin. Apparent with change temperature. Due to decreased BF through capillaries due to hypersensitivity of Bv to catecholamines
3. NF. Fucosidosis
4. Becomes indistinguishable

Question 8

Curric:
1. Internal associations TSC
2. Internal associations IP