Pigmentary Disorders (Vitiligo, Melasma)

A 26-year-old woman has symmetric depigmented macules on hands and around the mouth. Wood’s lamp shows bright blue-white accentuation. Best first-line for facial lesions?

A 34-year-old man presents with unilateral, dermatomal-like depigmented patches with early poliosis confined to the right chest; stable for 2 years. Most likely subtype and preferred intervention?

A 29-year-old woman notes diffuse shedding hyperpigmented patches on cheeks that darken with sun/visible light. Best foundational measure for melasma?

A 22-year-old with “white spots” on forearms has small, round hypopigmented macules, no scale, normal Wood’s lamp accentuation. Likely diagnosis?

A 31-year-old postpartum patient with new malar and forehead hypermelanosis asks for a safe agent while breastfeeding. Best choice?

A 40-year-old woman with nonsegmental vitiligo affecting 6% BSA asks about an FDA-approved topical that can repigment face and body.

A 19-year-old with well-demarcated depigmented patches on hands has normal labs except TSH mildly high and anti-TPO positive. Next best step?

A 27-year-old woman with melasma has tried sunscreen. Evidence-based first-line topical regimen?

A 33-year-old man has hypopigmented patches with fine scale on chest; KOH shows spaghetti-and-meatballs hyphae/spores. Best therapy?

A 45-year-old woman overuses hydroquinone 4% twice daily for a year for melasma. Now has blue-black paradoxical pigmentation on cheeks. Diagnosis?

A 16-year-old girl with well-circumscribed depigmented patch since birth, stable, with areas of hyperpigmented border and islands of normal pigment within. Diagnosis?

A 28-year-old with rapidly progressive nonsegmental vitiligo shows confetti depigmentation and Koebner phenomenon. Short-term systemic strategy to halt spread?

A 42-year-old man on amiodarone develops slate-gray hyperpigmented patches on the face in photo-exposed areas. Management?

A 35-year-old woman with melasma asks about lasers. Best counseling?

A 24-year-old with depigmented patches has white hairs within lesions (leukotrichia). What does this indicate?

A 30-year-old with melasma wants an oral option; no clotting risks. Evidence-based adjunct dose?

A 6-year-old boy with multiple hypopigmented “ash-leaf” macules accentuating under Wood’s lamp; one facial angiofibroma. Next step?

A 39-year-old woman with brown-gray facial hyperpigmentation on forehead/temples/neck; phototype IV; history of fragrance use. Most likely?

A 17-year-old swimmer develops linearly distributed brown streaks on legs after exposure to lime juice and sun. Diagnosis?

A 28-year-old with periorbital hyperpigmentation, atopically dry skin, and allergic rhinitis. Most helpful non-procedural measures?

A 52-year-old with melasma shows accentuation under Wood’s lamp limited to the epidermis. Which treatment responds best?

A 37-year-old with symmetric perioral depigmented patches; KOH negative; Wood’s lamp intensely accentuates. Which condition is clinically similar but does not accentuate strongly?

A 61-year-old with long-standing hemochromatosis displays diffuse “bronze” pigmentation. Mechanism?

A 20-year-old woman with vitiligo asks about camouflage. Best product class to recommend?

A 32-year-old with mixed-type melasma (epidermal + dermal) after pregnancy seeks non-hydroquinone depigmenters. Options?

A 44-year-old with segmental vitiligo stable 18 months wants surgery. Which predictor favors graft success?

A 50-year-old on minocycline for rosacea develops blue-gray pigmentation on shins and in acne scars. Best description/type?

A 31-year-old woman with vitiligo limited to periorbital/upper lip asks about targeted phototherapy.

A 48-year-old man with new reticulated hyperpigmentation on thighs from a space heater. Name and key step?

A 27-year-old with vitiligo on hands/feet asks about prognosis by site. Which is true?

A 36-year-old with melasma on OCPs asks about hormonal role. Counseling?

A 23-year-old with depigmented patches, tinnitus, and chronic bilateral uveitis; also poliosis. Syndrome?

A 14-year-old boy with symmetric hypopigmented facial patches with fine scale and atopy. Best management?

A 41-year-old woman with melasma worsens after switching to a non-tinted high-SPF sunscreen. Why?

A 55-year-old man with Addison disease shows diffuse hyperpigmentation accentuated in skin creases and oral mucosa. Pathophysiology?

A 30-year-old woman with nonsegmental vitiligo asks about treatment goals. Which statement is accurate?

A 28-year-old with mixed melasma has persistent dyschromia despite triple cream and sunscreen. Next-line evidence-based adjunct?

A 9-year-old girl has perioral/lip depigmentation with small confetti-like areas of loss; progressive for 3 months. Best initial therapy?

A 49-year-old with vitiligo involving >50% BSA seeks uniform appearance. Which therapy is used to depigment remaining normal skin?

A 26-year-old presents with hyperpigmented macules that recur at the same sites on lips and genital skin after NSAID ingestion. Diagnosis and course?

A 24-year-old woman with nonsegmental vitiligo on the face and trunk (8% BSA) asks about the most effective light therapy.

A 35-year-old man with stable, focal vitiligo on the dorsal hands wants surgical treatment. Which technique best fits small, stable patches?

A 17-year-old girl with vitiligo shows perifollicular repigmentation during NB-UVB. What does this pattern indicate?

A 29-year-old postpartum woman with centrofacial melasma asks about safe peeling options.

A 28-year-old man with rapidly spreading vitiligo and “confetti” lesions asks about short systemic therapy.

A 41-year-old woman with mixed melasma (Wood’s lamp accentuates partially) failed triple cream. Evidence-based next adjunct?

A 33-year-old with periorbital and perioral vitiligo asks about targeted devices.

A 45-year-old man with lichen planus pigmentosus (slate-brown macules in flexures) wants treatment.

A 26-year-old woman with acrofacial vitiligo asks which sites respond worst.

A 31-year-old man develops sharply demarcated depigmented patches at adhesive contact sites from a rubber plant. Diagnosis?

A 52-year-old woman with dermal/mixed melasma asks about lasers. Which statement is accurate?

A 23-year-old with nonsegmental vitiligo involving lips (mucosal). Best initial approach?

A 37-year-old woman on OCPs with malar melasma asks about contraception.

A 40-year-old man with postinflammatory hyperpigmentation after acne wants rapid clearance.

A 26-year-old with vitiligo asks about supplementation. Which has some evidence as adjuvant to NB-UVB?

A 34-year-old woman with melasma and phototype V fears irritation. Which non-hydroquinone combo is reasonable?

A 28-year-old man on clofazimine develops reddish-brown hyperpigmentation. Counseling?

A 32-year-old with vitiligo is starting topical ruxolitinib. Key safety counseling?

A 46-year-old with dermal melasma on cheeks asks about microneedling with tranexamic acid.

A 21-year-old athlete develops linear brown streaks on thighs after topical NSAID gel plus sun. Diagnosis?

A 19-year-old with segmental vitiligo stable for 2 years wants micropigmentation. Best counseling?

A 53-year-old woman with facial gray-brown netlike pigmentation and chronic fragrance/cosmetic use. Patch testing confirms allergy. Core management?

A 27-year-old with vitiligo experiences new depigmented streaks at sites of scratches. Phenomenon?

A 60-year-old with diffuse melasma-like pigmentation but also mucosal and nail hypermelanosis; low cortisol and high ACTH. Diagnosis?

A 36-year-old woman with periorbital PIH after eczema flares seeks safer steroid-sparing option.

A 42-year-old man with vitiligo limited to nipples and areolae (mucocutaneous). Best therapy?

A 33-year-old with melasma asks why tinted sunscreen is emphasized.

A 25-year-old with vitiligo considers depigmentation for 90% BSA involvement. Appropriate agent/counseling?

A 47-year-old with erythema dyschromicum perstans (ash-gray macules) asks about treatment.

A 30-year-old with vitiligo beginning around body piercings and scars. Prevention advice?

A 39-year-old with pregnancy-induced melasma postpartum wants to breastfeed. Safe topical plan?

A 22-year-old man with vitiligo asks about associated autoimmune screening.

A 28-year-old with phototype V develops PIH after inflammatory acne and aggressive picking. Best prevention strategy?

A 58-year-old on hydroxychloroquine for SLE develops diffuse gray–blue pigmentation on shins/face. Next step?

A 40-year-old woman with vitiligo complains of significant psychosocial distress. Helpful non-pharmacologic intervention?

A 34-year-old receives PD-1 inhibitor for melanoma and develops vitiligo-like depigmentation. Counseling?

A 48-year-old man with mandibular-distributed melasma asks about pattern subtypes.

A 29-year-old with vitiligo on eyelids develops irritant dermatitis from multiple creams. Best workaround?

A 55-year-old with hemochromatosis asks why he has “bronze” skin.

A 38-year-old with extensive, treatment-refractory vitiligo opts for depigmentation. What long-term risk must be emphasized?