A 60-Year-Old Man With Facial Vitiligo

Introduction. A 60-year-old man presents to his internist requesting a discussion on treatment options for his facial vitiligo.

Patient history. The patient recently saw TV advertisements heralding a cream that is now FDA approved for vitiligo, and he was curious about the cream’s efficacy for his facial vitiligo, which has never been treated previously.

The patient first presented with vitiligo when he was about 15 years of age. At that time, he had experienced mouth trauma requiring several dental extractions and surgical repairs in the months prior. He always questioned whether the repairs or the trauma triggered the vitiligo, which involved an area near and above his left upper lip and paranasal region (measureing at roughly 6 x 4 cm arear). He recalls the lesion had an abrupt onset to its approximate current size with quick stabilization and no progression then or since.

The patient noted that there is no personal or family history of other autoimmune disorders. When asked, he noted that neither he nor his family (he is married with grown children) or friends essentially "notice" the vitiligo anymore, and he does not believe it ever impacted his quality of life.

Physical examination. The patient’s physical examination is entirely within normal limits. The only notable finding during his physical examination was the unpigmented area on his skin, which otherwise has a dark, Mediterranean complexion consistent with his family's background.