PHOTO ROUNDS Somya Abubucker, MD; Bernard Cohen, MD Depigmented plaques on vulva University of Hawaii, Honolulu (Dr. Abubucker); Johns Hopkins University School of Medicine, The distinctive pattern of our young patient’s skin Baltimore, Md (Dr. Cohen) changes made the diagnosis clear.
[email protected] DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health a mother brought her 8-year-old besides herself. Her mother was concerned at San Antonio daughter to our office for evaluation of vit- that the white spots might spread to the rest The authors reported no potential iligo “down there” (FIGURE). The skin erup- of her daughter’s body, which could affect her conflict of interest relevant to this tion first appeared on her vulva a year earlier socially. article. and was intermittently pruritic. The lesions were initially smaller and red, but had since lightened in color, coalesced, and had begun ● WHAT IS YOUR DIAGNOSIS? to spread to the perianal area. The patient’s mother had received a call from her daugh- ● HOW WOULD YOU TREAT THIS ter’s teacher who observed that her daughter PATIENT? was scratching the area and might be mastur- bating in class. FIGURE The mother reported that 6 months Depigmented plaques earlier, her daughter had experienced bloody spots in her underwear accompanied by dys- in a figure-8 pattern uria. The mother brought her to the emer- gency department, where she was treated with antibiotics for a urinary tract infection. Our physical examination revealed well- circumscribed, symmetric, depigmented, confluent, crinkled, parchment-like plaques with small hemorrhagic erosions on the me- dial labia majora and minora.