00:01
Next up, Vitiligo.
00:04
A vitiligo is characterized by
very well demarcated,
hypopigmented macules
that can certainly coalesce
into large patches,
as we're seeing
in this gentleman.
00:15
It's an autoimmune disease
attack on the melanocytes.
00:18
It has nothing to do
with any fungal infections.
00:21
And the risk factors are having
other autoimmune diseases.
00:25
Oftentimes, you'll see patients
have a history of type 1 diabetes,
which I believe
our patient did report.
00:31
Graves disease,
maybe rheumatoid arthritis
or pernicious anemia,
you get the point.
00:36
These lesions are non-puritic.
00:38
You really shouldn't see any scale.
00:41
And they're usually
on the face,
the genitals,
and probably the most
often location we see them
is on the hands.
00:49
The disease course,
the natural history,
is fairly unpredictable.
00:52
We really don't have
any curative therapies
but we can use as steroids
which you can inject into the skin.
00:58
Phototherapy can help.
01:00
And also there's evidence
that calcineurin inhibitors
like tacrolimus
and pimecrolimus
can be helpful as well.
01:07
Well, I'm thinking that with her
hypopigmented macules
on the face and the neck
as well as her history of
type 1 diabetes,
we're probably obligated
to keep vitiligo
on our list for now.
01:18
This is going to be
one of those instances
where a KOH prep
will be really helpful.
01:22
And lastly, we should just mention
Candida intertrigo.
01:25
Again, she is diabetic.
01:27
She is somewhat
immunocompromised,
and thus, potentially
at higher risk.
01:31
Are those lesions on her face,
satellite lesions?
Again, typically, with Candida
you're going to see hyperpigmented
or really erythematous lesions,
which is not what we're seeing here.
01:43
So I think we can safely take
Candida intertrigo
off of our list.
01:48
All right,
to confirm our diagnosis
and to tease apart
these last two items,
we'll need to get a KOH prep,
which I can tell you shows
Malassezia globosa
hyphae and spores
the so called
spaghetti and meatballs pattern.
02:01
and so our final diagnosis is
tinea versicolor.
02:05
Now, like most tinea,
this can be treated
with topical antifungals
like fluconazole or
selenium sulfide shampoo.
02:14
So, let's highlight a few points
in our case.
02:17
As I mentioned, she has well control
type 1 diabetes,
It puts us at risk for certain
things like vitiligo,
but in this case, that was not going
to be the most salient feature.
02:26
The rashes on her chest,
her face, her neck,
that's a very typical location,
for these hypopigmented macules
of tinea versicolor.
02:33
Again, the tripdown to the tropics
could increase the risk
of these developing
and these lesions
ought not to be itchy.
02:40
Multiple scaly
hypopigmented macules,
coalescing into large patches,
that would be
a very common presentation
for this condition.
02:49
All right, so let's highlight
a few key points
about fungal skin infections.
02:53
We've talked about
the tinea family,
tinea corporis or ringworm,
tinea capitis on the scalp,
Tinea cruria in the called
jock itch, oftentimes.
03:04
Tinea pedis, which can be around
a two different patterns
either the moccasin type or
the interdigital maturation type,
and then tinea unguium,
also known as onychomycosis.
03:14
We talked about
Candida albicans,
which commonly can cause
candidal intertrigo
underneath the breasts,
in the axilla, in the groin,
or underneath penis.
03:23
We talked about
tinea or pityriasis versicolor
caused by
malassezia globosa.
03:29
We talked about how you can diagnose
all of those fungal infections
by just doing a skin scraping
and putting some of the scale
onto a slide
putting a drop of KOH prep on there
and looking for the
spagetti or meatballs hyphy
and other features
of a fungal infection.
03:46
And lastly, you can treat
most of these
with either topical,
or oral antifungals
like the azoles or terbinafine.
The lecture Vitiligo by Stephen Holt, MD, MS is from the course Skin Infections.
Which of the following statements is correct regarding vitiligo?
Which of the following conditions is NOT considered a risk factor for vitiligo?
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