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QUESTION 6-1. An 8-year-old girl presents to her dermatologist with hypopigmented patches on the trunk. A biopsy of one of the lesions is performed. Immunohistochemical staining with Melan-A is illustrated below. Which entity on the clinician’s differential diagnosis is NOT supported by the biopsy findings?

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A) Piebaldism

B) Vitiligo

C) Hypopigmented burn scar

D) Ash leaf spots of tuberous sclerosis

E) Waardenburg syndrome

QUESTION 6-2. A child presents with white hair, milky white skin, and blue-gray eyes. The condition has been present since birth. A plucked hair bulb does not become darker after incubation in DOPA solution. Which of the following statements is MOST accurate regarding this patient’s condition?

Reproduced, with permission, from Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York, NY: McGraw-Hill Education; 2013.

A) Biopsy of the skin will reveal a paucity of melanocytes.

B) This patient may develop freckles and pigmented nevi later in life.

C) This condition is associated with alterations in the optic systems that will manifest as decreased visual acuity, nystagmus, and photophobia.

D) The mutated gene in this disorder normally encodes a protein thought to play a role in regulating organelle pH and vacuolar accumulation of glutathione.

E) Sunburns are unusual.

QUESTION 6-3. A 27-year-old female with long-standing discoid lupus presents with concerns regarding the appearance of some lesions on her cheeks, nose, and forehead. On physical exam there are several atrophic depigmented plaques and patches surrounded by hyperpigmentation and erythema associated with alopecia. The patient’s medication list includes hydroxychloroquine and naproxen. Which of the following statements is MOST accurate regarding this patient’s leukoderma?

Reproduced with permission from Kasper DL, Fauci A, Hauser SL et al: Harrison’s Principles of Internal Medicine. 19th ed. New York, NY: McGraw-Hill Education; 2015

A) The depigmentation is most likely attributed to an acquired defect in tyrosinase.

B) This patient’s depigmentation is completely reversible with regeneration of basilar melanocytes and keratinocyte melanin pigment.

C) This patient likely has a lichenoid drug eruption that is resolving with post-inflammatory hypopigmentation. She should stop her medications, and ...

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