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Does this woman have Vitiligo?

64 year old woman presents for the evaluation of multiple white spots on her legs and arms that have been developing over the "past few years". They are increasing in number, but not size. She is very worried that she's developing "the skin disease Michael Jackson had". Mild medically controlled hypertension. She is otherwise healthy..

What is your diagnosis?

Case of the Month

Idiopathic Guttate Hypomelanosis

(also known as Leukopathia Symmetrica Progressiva)

Idiopathic Guttate Hypomelanosis is a very common acquired disorder that affects women more frequently than men; it usually occurs most notably after age 40. Many patients present for evaluation because they are very concerned that they are developing Vitiligo. It probably affects about 50% of all people to some extent in their 40's and 70% of people in their 60's+. The darker the skin hue, the more noticeable it is. The lesions occur chiefly on the shins and forearms but I have seen them on all areas of the body. They range in size from approximately 2-6+mm. They rarely become very numerous (a dozen or two at most) but some patients will develop more than that. The lesions are usually round to oval in shape and are very sharply defined, like depigmented ephelides. Aside from assuring the patient that they do not have Vitiligo, they are of only minor cosmetic significance. Histopathologically, the melanocytes appear to be present (but may be at reduced numbers), are less dendritic and are producing melanin at a greatly decreased or absent rate.

There are reports that very light liquid nitrogen freezing has successfully treated the lesions.


  1. Falabella R, et al: On the pathogenesis of Idiopathic Guttate Hypomelanosis. J Am Acad Dermatol 1987, 16:35
  2. Andrews Diseases of the Skin and Clinical Dermatology
  3. Dover's Pocket Guide to Cutaneous Medicine and Surgery


Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology

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