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JAMA Clinical Challenge | Clinician's Corner

Hypopigmented Patches on the Skin

Elizabeth Juhas , MD; Joseph C. English III, MD
JAMA. 2013;309(4):392-393. doi:10.1001/jama.2012.211717.
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A 47-year-old man presents with a 1-year history of a mildly pruritic eruption on the trunk and extremities. He has no significant medical history and takes no medications. He denies any recent travel or close contact with persons or animals having a similar eruption. Review of systems is negative. On physical examination, he has hypopigmented round patches with fine cigarette-paper scaling centrally located on his proximal arms, hips, thighs, lateral chest wall, and flanks (Figure 1). Sensation is intact over the affected skin. Examination of skin scrapings using potassium hydroxide is negative for hyphae, and there is no palpable lymphadenopathy.

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Figure 1. Hypopigmented patches with fine scaling on the right upper thigh.
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Figure 2. Skin biopsy from patient's hip demonstrating atypical lymphocytes with prominent epidermotropism (movement of the lymphocytes to the epidermis) and focal pigment incontinence (detail, arrowheads) in the papillary dermis and at the dermoepidermal junction. The lymphocytes in the epidermis are larger than those in the dermis and may demonstrate cerebriform nuclei (hematoxylin-eosin,original magnification ×20).
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