Medical history Female patient, 2 year and 7 months old. Her mother reports hypopigmented, non-pruritic lesions on the patient’s face (image 1) and trunk, which have been present from the first months of her life. Recently, the face lesion has become more visible, which caused esthetic discomfort. The patient presents with diffusely dry skin; worsening of symptoms is observed after hot showers. Previous history of atopic dermatitis. Image 1: Photograph of the patient’s left malar region. Question:Considering the clinical history and images presented, what is the most likely diagnosis of the lesion? Indeterminate Hansen’s disease Pityriasis alba Pityriasis versicolor Vitiligo Test question COREME - Pediatria HC UFPR - 2017) Six-year-old male patient presents with hypochromic lesions on the face with smooth peeling, which appeared in the past three months. His mother reports symptoms onset after summer and associates them to “worm infection”. Clinical examination shows hypochromic macules with poorly defined margins, measuring 2 to 3cm in diameter, on the malar region, with tender, furfuraceous desquamation. Thermal and pain sensitivity tests did not show any alterations. Histamine test demonstrated triple response of Lewis. Question:Considering the clinical history, the diagnosis is: Pityriasis versicolor, which can be confirmed by the hypochromic aspect of the lesions and their onset after summer; treatment is based on systemic antifungals Tinea faciei, which is caused by Microsporum fungal infection. Topical antifungals are used for treatment Pityriasis alba, a common dermatosis among infants. Treatment is skin hydration and sun protection Vitiligo, which is characterized by hypochromic, asymptomatic lesions; Treatment is based on systemic corticosteroid therapy Indeterminate Hansen’s disease; even though the sensitivity test showed no alteration; treatment is polychemotherapy Time is Up! Time's up
