Chapter 50: Pigmentation Changes

Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A parent reports the appearance of areas of depigmented skin on a child which has spread rapidly. The provider notes asymmetrically patterned tri-colored, macules in a dermatomal distribution. What type of vitiligo does the provider suspect?

a. Inflammatory vitiligo b. Segmented vitiligo c. Type A vitiligo d. Vitiligo with poliosis

ANS: B a. Applying a cosmetic cover-up or tanning cream b. Lightening the dark skin areas with hydrogen peroxide c. Tanning for limited periods in a tanning booth d. Waiting for all skin to become depigmented

Segmented, or dermatomal vitiligo, spreads rapidly, is usually asymmetrical, and tends to occur in children. Inflammatory vitiligo occurs after inflammation of the skin. Type A vitiligo is non-dermatomal and is generally symmetric. Poliosis occurs when well-defined areas of white hair occur.

2. A patient who is diagnosed with vitiligo asks the provider what can be done to minimize the contrast between depigmented and normal skin. What will the provider recommend?

NURSINGTB.COM

ANS: A a. Chemical depigmentation with mequinol b. Narrow-band ultraviolet B light therapy c. Psoralens plus ultraviolet A light d. Twice-daily application of a mid-potency steroid cream

Cosmetic cover-ups or tanning creams are useful to help darken affected areas. Hydrogen peroxide is not recommended. Tanning is contraindicated; excessive sunburn can stimulate depigmentation. Waiting for widespread depigmentation is unpredictable.

3. A patient diagnosed with well-localized vitiligo is referred to a dermatologist for treatment. What will the initial treatment be?

ANS: D

The initial treatment for vitiligo is twice-daily mid-potency steroids. UVA and UVB therapy with psoralens may be used if this isn’t effective and must be performed by a qualified specialist. Patients with widespread areas of vitiligo may be treated with depigmentation therapy.