Presenter:  Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

Program Director: Rick Lin, DO MPH FAOCD

Submitted on: March 22, 2023

CHIEF COMPLAINT:  “I have a pale spot on my neck”

CLINICAL HISTORY: A 14-year-old Hispanic female with a history of acne vulgaris presents to our clinic with concern for a hypopigmented, atrophic patch on the left side of her neck. Per the patient’s mother, she first noticed the lesion when she took the patient to the pediatrician a few days prior to this visit. The patient tried topical benzoyl peroxide-clindamycin gel on the spot that was prescribed for her back acne. She denied itching, pain, or systemic symptoms. She also denies recent travel, sick contacts, excessive sweating, smoking, alcohol, or illicit drug use. Patient denies any personal or family history of skin cancer. 

PHYSICAL EXAM:
On physical examination, the patient has a solitary, well-circumscribed, atrophic and hypopigmented patch 1cm x 2cm on the left lateral neck. 

LABORATORY TESTS: N/A

DERMATOHISTOPATHOLOGY:

Histopathologic studies demonstrated perivascular and interstitial infiltrate of atypical lymphocytes with epidermotropism, an elevated CD4: CD8 ratio, and PAS negativity for fungi. Fontana Masson stain highlighted decreased epidermal melanin.

DIFFERENTIAL DIAGNOSIS:

1.    Pityriasis Alba
2.   Tinea Versicolor
3.   Tinea Corporis
4.   Post inflammatory Hypopigmentation
5.   Pityriasis Lichenoides Chronica
6.   Mycosis Fungoides