Lichen sclerosus and depigmented extramammary Paget disease can manifest with depigmentation and should be considered in any patient with genital vitiligo-like depigmentation.
Malignant melanoma should be considered in adults who present with a depigmented macule or patch and a history consistent with regression of a pigmented neoplasm.
Any patient with progressive depigmentation and visual complaints should be referred to a retinal specialist to evaluate for Vogt-Koyanagi-Harada disease and Alezzandrini syndrome.
Obtaining a biopsy specimen should be considered in patients with depigmentation associated with epidermal changes (eg, atrophy), induration, sensory changes, alopecia, or depigmentation that is refractory to conventional treatment.
Several circumstances may interfere with the patch test results, like acute dermatitis, intensive UV exposure or long-term pretreatment with topical corticosteroids.
Psoriasis in patients with HIV infection usually involves the face in a seborrhoeic distribution, flexures and extremities including the nails.
Plaques are often red, raw and may be sore.
Topical tretinoin has been reported effective in treating milia en plaque and more generalized forms of milia involving the face. Minocycline has also been used to treat milia en plaque.
Oral antiviral agents are recommended in all patients over age 50 with herpes zoster and pain who still have blisters, even if the drugs are not given within the first 96 hours of the eruption.