A pair of pigment disorders

CASE #1

A 60-year-old man hospitalized for pericarditis likely related to systemic lupus erythematosus (SLE) was brought to the dermatology clinic for examination of a large white macule interspersed with brown follicular macules. The border of the white macule was smooth. A Wood’s lamp examination showed that the white area was depigmented, while the brown macules were similar in appearance to normal skin. On palpation, the white macule was found to be sclerotic. The patient also was noted to have periungual telangiectasias, tapered fingers with waxlike rigidity, and a masklike facies.

CASE #2

A Hispanic woman, aged 42, presented with extensive depigmented macules on her chest, arms, legs, abdomen, and back. The macules had a scalloped border and were bright white when examined with a Wood’s lamp. In amongst the depigmented plaques were perifollicular and follicular brown macules. The patient, who had been treated at a phototherapy center for a “skin disease,” stated that the appearance of her eruptions was improving. Laboratory testing revealed a negative antinuclear antibody titer, normal thyroid function, and normal vitamin B12 level. One of the patient’s aunts had Graves’ disease.

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