Race for the Case

Race for the Case is a clinical quiz feature published quarterly in DermWorld Directions in Residency — and right here!

Answer the questions below to enter. Looking for the Fall 2021 answers? Review them now.

Diagnose this case by François Lagacé, MD, and Zeinah AlHalees, MD

An otherwise healthy 54-year-old male presented to the dermatology clinic with a history of asymptomatic skin discoloration. He first noticed a few spots appearing on his hands bilaterally, then the lesions started to spread all over his body. His review of systems was negative, and he was not on any medications. He was referred by his family doctor for further management due to progression of his skin lesions despite trying topical corticosteroids. The physical exam revealed numerous circumscribed, depigmented macules and patches on his face, trunk, and extremities surrounded by normal skin. Leukotrichia within depigmented patches was noted, as well as areas of perifollicular repigmentation on his dorsal hands. No other signs were evident. He recently had a routine follow-up with his family doctor and no other issues or laboratory abnormalities were identified.

1. What bedside tool can be used to help aid in diagnosis?
   Please explain its mechanism of action.

2. How is this disease classified?

3. What are other disorders that are associated with this skin condition?

4. Mention four therapeutic options from different categories that can be used for the treatment of this disease.

5. What are the criteria that must be fulfilled for surgical intervention to be considered?

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