Progressive Depigmented Patch in Young Adult Female

Case at a Glance

A 28-year-old female presents with a progressively enlarging white patch on her skin that has been expanding over a 2-year period, initially evaluated by primary care with referral pending to dermatology.

Patient's Story

The patient noticed a small white patch on her skin approximately 2 years ago. Over time, she observed that the patch has been gradually increasing in size. She reports no associated symptoms such as itching, pain, or scaling. Notably, she mentions that freckles within the affected area have been disappearing. She has no history of other dermatological conditions and is not currently taking any medications. Due to healthcare system constraints, she has been placed on a waiting list for dermatological evaluation.

Initial Assessment

Primary care physician examination revealed a depigmented patch with unclear etiology. The patient appeared otherwise healthy with no systemic symptoms. Initial differential diagnosis was broad given the limited dermatological expertise available at the primary care level.

The Diagnostic Journey

Given the progressive nature of the lesion and the loss of pigmentation including freckles in the affected area, clinical presentation suggested an acquired depigmentation disorder. The gradual enlargement over 2 years and the characteristic appearance led to consideration of vitiligo as the primary diagnostic possibility.

Final Diagnosis

Clinical diagnosis of vitiligo based on characteristic presentation of progressive depigmentation with loss of melanocytes in the affected area, supported by the disappearance of freckles within the patch.

Treatment Plan

Patient education regarding the benign nature of vitiligo. Dermatology referral maintained for formal evaluation and discussion of treatment options, which may include topical corticosteroids, calcineurin inhibitors, or phototherapy depending on extent and patient preferences.

Outcome and Follow-up

Patient reassured regarding the harmless nature of the condition. Awaiting formal dermatological consultation for comprehensive evaluation and potential treatment planning. Patient advised to monitor for any changes and to protect affected areas from sun exposure.