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JAMA Dermatology Clinicopathological Challenge
July 14, 2021

Chronic, Scaly, Hypopigmented Macules on the Face

Author Affiliations
  • 1Uniformed Services University, Bethesda, Maryland
  • 2Evans Army Community Hospital, Ft Carson, Colorado
  • 3Confluence Health, Wenatchee, Washington
JAMA Dermatol. Published online July 14, 2021. doi:10.1001/jamadermatol.2021.2466

An otherwise healthy Black woman in her 30s presented to the dermatology clinic for evaluation of hypopigmented, intermittently pruritic patches. Patches were confined to her face and neck and occurred intermittently after her last pregnancy approximately 10 years ago. She had no history of eczema, atopic skin conditions, or autoimmune conditions and denied family history of such. In previous evaluations, the areas were treated with petroleum-based creams, low- to medium-potency topical steroids, pimecrolimus, and topical antifungals, without consistent improvement. Physical examination identified multiple hypopigmented macules and subtle patches symmetrically distributed across the lower aspect of the forehead, cheeks, nasofacial sulci, and nasolabial folds; and along the jawline and neck (Figure, A and B). Many had a slight overlying scale that was tested with potassium hydroxide and was negative for hyphae. No hair or nail abnormalities were noted. A 4-mm punch biopsy of a hypopigmented patch on the right cheek was performed (Figure, C and D).

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