Image Challenge 15: Hypopigmented Macules - Identify the cause?

April 17, 20093comments

These lesions became more evident after the skin was illuminated with Wood's light. What diagnosis is suggested?
1. Pityriasis rosea
2. Melanoma
3. Tuberous sclerosis
4. Psoriosis
5. Vitiligo

Enter your answer in comments section.

Courtesy: The New England Journal of Medicine

Surprise Gifts await the first three correct entries!

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fathima begum
April 18, 2009 at 10:39 AM

It is 3. Tuberous sclerosis.. Tuberous sclerosis is a genetic disorder affecting cellular differentiation and proliferation, which results in hamartoma formation in many organs that causes non-malignant tumours to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. A combination of symptoms may include seizures, developmental delay, behavioural problems, skin abnormalities, lung and kidney disease. TSC is caused by mutations on either of two genes, TSC1 and TSC2, which encode for the proteins hamartin and tuberin respectively .These proteins act as tumour growth suppressors, agents that regulate cell proliferation and differentiation.
A full clinical diagnosis involves
Taking a personal and family history.
Examining the skin under a Wood's lamp (hypomelanotic macules), the fingers and toes (ungual fibroma), the face (angiofibromas) and the mouth (dental pits and gingival fibromas).
Cranial imaging with non enhanced CT or, preferably, MRI (cortical tubers and subependymal nodules).
Renal ultrasound (angiomyolipoma or cysts).
An echocardiogram in infants (rhabdomyoma).
Fundoscopy (retinal nodular hamartomas or achromic patch).

April 20, 2009 at 2:10 PM

The unknown image is found to be VITILIGO.This is a patchy loss of melanin from the epidermis causing areas of pale skin.There may also be loss of melanin in hair follicles. It is usually seen as an auto-immune disease. The patches of vitiligo tend to be clearly circumscribed areas of whiteness. A Wood's light can be helpful to exclude superficial fungal infections that fluoresce in the ultra-violet light. If a Wood's light is shone on areas of depigmentation the exact margin is more readily seen on fair skin and the lesions appear a bright blue-white.

April 22, 2009 at 8:52 PM


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