Vitiligo

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.