White Lesions on the Hands and Lower Extremities

Alexander K.C. Leung, MBBS; Benjamin Barankin, MD

Am Fam Physician. 2019;99(2):125-126.

Abstract and Introduction

Introduction

A 16-year-old girl presented with asymptomatic, white lesions on the hands and lower extremities. The lesions were first noted five years earlier and had slowly increased in size. There was no family history of a similar skin disorder or autoimmune disease.

Physical examination revealed well-demarcated, chalk-white macules and patches on the dorsum of the hands (Figure 1) and extensor aspects of the legs.

(Enlarge Image)

Figure 1.

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Abstract and Introduction
Question
Discussion
References

Summary Table
Condition	Onset	Location	Prognosis	Characteristics
Hypomelanosis of Ito	Birth or first two years of life	Trunk and proximal extremities	Tends to fade in adulthood	Patterned, hypopigmented macules in well-demarcated streaks, stripes, whorls, and patches
Idiopathic guttate hypomelanosis	More common after 30 years of age	Areas with repeated sun exposure, such as forearms and shins	Tends to persist and may slowly enlarge	Asymptomatic, discrete, well-circumscribed, smooth, porcelain-white macules with round or angular borders
Pityriasis alba	Three to 16 years of age	Face	Spontaneous resolution in two to three years	Asymptomatic, hypopigmented, round or oval macules and patches with fine, loosely adherent scales and indistinct borders
Tinea versicolor	Adolescents and young adults	Trunk, upper arms, and neck	Tends to persist and may slowly enlarge	Asymptomatic, hypo- or hyperpigmented macules that are covered with a fine scale
Vitiligo	Usually before 40 years of age	Face, neck, limbs, trunk	Slowly progressive	Asymptomatic, acquired, well-demarcated, milky or chalk-white macules or patches