This is especially true of albinism. BS consists of asymptomatic, small, irregular, hypopigmented macules characterized by a normal histological appearance, which are usually found in individuals aged 20-40 and more frequently in women than men. The frequency of IGH increases with age. It is necessary to perform a clinical differential diagnosis of hypopigmented lesions, including vitiligo, idiopathic guttate hypomelanosis, tinea versicolor, and postinflammatory hypopigmentation. The differential diagnosis of pityriasis alba includes the following: Postinflammatory pigment alteration. The pigment cells or melanocytes are located at the base of the epidermis and produce the protein melanin.Melanin is carried by keratinocytes to the skin surface. Obsessive compulsive disorder (OCD) – The obsessive thoughts and repetitive actions seen in OCD can appear Erythema, scale, and papules within these macules and patches are variable. Case presentation A 7-year-old girl presents with a small number of hypopigmented macules on her back that have been present for about three months (Figure 1). The hypopigmented macules progress to full depigmentation. Quadrichrome vitiligo features a fourth, dark-brown pigment, which surrounds hair follicles. Differential diagnosis. The macules are well circumscribed and each has a central raised lesion. Differential diagnosis Conditions to include in the differential diagnosis include the following. Pigmenting pityriasis alba. Pigmentation of the skin normally varies according to racial origin (see Fitzpatrick phototypes) and the amount of sun exposure.Pigmentation disorders are often more troublesome in skin of colour.. This is a broad category of differential diagnoses with variable symptomatology depending on the specific diagnosis. Introduction. Hypochromic naevus (naevus depigmentosus). Lesions of pityriasis alba are usually bilateral and located on the face, arms, and neck. Lesions often occur on the head, neck, upper extremities, trunk, and buttocks. Nevus depigmentosus. A well-defined, hypopigmented, irregularly shaped, confluent macules forming a patch that is usually found on the trunk; It presents at birth or early in childhood and persists in to adulthood remaining unchanged; Stroking, rubbing, or warming induces erythema of the adjacent normal skin 1 Frequency of the condition is much lower in … Hypopigmented MF presents with hypopigmented macules and patches. DISCUSSION. In these cases, the skin is more vulnerable to damage from ultraviolet rays. a. When faced with a patient with hypopigmented macules, the differential diagnosis should include tinea versicolor, pityriasis alba, vitiligo, tuberculoid leprosy, and idiopathic guttate hypomelanosis. The differential diagnosis is challenging as TFI resemble many other dermatologic conditions. 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