Vitiligo vs Albinism and tinea versicolor
How to tell Vitiligo and Albinism and tinea versicolor apart when a board question makes them look alike.
Vitiligo is acquired autoimmune depigmentation; albinism is congenital melanin synthesis defect; tinea versicolor is scaly Malassezia pigment change.
Side by side
Vitiligo causes acquired depigmented macules from autoimmune melanocyte loss, often sharply demarcated and associated with autoimmune disease.
Albinism is congenital impaired melanin synthesis with diffuse hypopigmentation and normal melanocyte number; tinea versicolor causes hypo/hyperpigmented fine-scaling patches with Malassezia.
Autoimmune destruction removes melanocytes from affected skin.
Albinism reduces melanin production; tinea versicolor yeast interferes with pigment and creates superficial scale.
Wood lamp accentuation, absent melanocytes in lesions, and autoimmune history support vitiligo.
Congenital diffuse pigment reduction supports albinism; KOH spaghetti-and-meatballs supports tinea versicolor.
The trap
Light patches overlap, so congenital versus acquired, scale, KOH, and melanocyte presence separate them.
The repair move
For hypopigmentation, distinguish congenital from acquired and check for scale: (1) VITILIGO is ACQUIRED autoimmune destruction of melanocytes, with sharply demarcated depigmented (chalk-white) patches on face, hands, axillae, genitals, peri-orificial areas; biopsy shows ABSENT melanocytes; associated with other autoimmune diseases (autoimmune thyroid disease, type 1 diabetes, Addison disease, pernicious anemia); treat with topical steroids, topical calcineurin inhibitors, narrowband UVB phototherapy, JAK inhibitors (ruxolitinib topical). (2) ALBINISM is CONGENITAL autosomal recessive defect in melanin synthesis (most commonly tyrosinase deficiency in oculocutaneous albinism); biopsy shows PRESENT melanocytes but no melanin; complete absence of pigmentation since birth with photophobia, nystagmus, decreased visual acuity, and high skin cancer risk (sun protection critical). (3) TINEA VERSICOLOR (pityriasis versicolor) is Malassezia furfur causing PATCHY hypopigmentation OR hyperpigmentation on trunk and shoulders, with FINE scale; KOH shows spaghetti-and-meatballs pattern (short hyphae plus yeast); treat with topical selenium sulfide, ketoconazole, or oral fluconazole.
Try a free question
CoreA 28-year-old woman with a history of autoimmune hypothyroidism has developed sharply demarcated DEPIGMENTED (completely white) macules on the dorsa of her hands, periorbital and perioral skin over the past 6 months. Wood's lamp examination accentuates the depigmentation. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Vitiligo. Vitiligo is an acquired autoimmune destruction of melanocytes producing sharply demarcated depigmented macules and patches, often in periorificial, acral, and trauma-prone sites; associated with other autoimmune disorders (thyroid, type 1 diabetes, Addison disease); treatment options include topical corticosteroids, topical calcineurin inhibitors, and phototherapy.
Why the other choices are tempting
- B. Albinism is a CONGENITAL melanin synthesis defect with diffuse hypopigmentation from birth (skin, hair, eyes).
- C. Tinea versicolor has hypopigmented or hyperpigmented scaly patches with positive KOH for Malassezia 'spaghetti and meatballs'.
- D. Post-inflammatory hypopigmentation follows a specific prior inflammatory event.
- E. Pityriasis alba is mild hypopigmentation in atopic children, often on the face.
Flashcards
Tap a card to flip it.
What organism causes tinea versicolor?
Malassezia causes tinea versicolor, producing scaly pigment change with spaghetti-and-meatballs KOH.
What mechanism causes vitiligo?
Autoimmune melanocyte destruction causes vitiligo.
Quick answers
What is the fastest way to tell Vitiligo from Albinism and tinea versicolor?
Vitiligo is acquired autoimmune depigmentation; albinism is congenital melanin synthesis defect; tinea versicolor is scaly Malassezia pigment change.
What is the key clue for Vitiligo?
Vitiligo causes acquired depigmented macules from autoimmune melanocyte loss, often sharply demarcated and associated with autoimmune disease.
What is the key clue for Albinism and tinea versicolor?
Albinism is congenital impaired melanin synthesis with diffuse hypopigmentation and normal melanocyte number; tinea versicolor causes hypo/hyperpigmented fine-scaling patches with Malassezia.
What is the common trap with Vitiligo vs Albinism and tinea versicolor?
Light patches overlap, so congenital versus acquired, scale, KOH, and melanocyte presence separate them.