Snapshot A 5-year-old boy is brought to the pediatrician’s office for evaluation of “white patches.” His mother is worried that he has vitiligo. These white patches started a few weeks ago after a month-long summer camp. The child has a history of atopic dermatitis and severe food allergies. On physical exam, he has multiple 1-3 cm irregular but well-defined patches of hypopigmentation on his cheeks, upper arms, and chest. There is overlying scaling and minimal erythema. His mother is counseled about the benign nature of this disease and recommends topical moisturizers and topical corticosteroids to minimize symptoms. Introduction Clinical definition cutaneous benign dermatosis of hypopigmentation of unknown etiology Epidemiology demographics children ages 3-16 years of age risk factors atopic dermatitis sun exposure frequent bathing Etiology unknown Pathogenesis exact mechanim is unknown but this disease is thought to be due to residual postinflammatory hypopigmentation and may be related to sun exposure Associated conditions atopic dermatitis Prognosis self-limited disease repigmentation takes months to years Presentation Symptoms may be pruritic Physical exam < 5 cm in diameter macules and patches of hypopigmentation location face neck trunk proximal extremities features well-defined but irregular borders overlying fine scaling faint erythema Studies Wood’s lamp examination no fluorescence KOH preparation to rule out dermatophyte infection Histology nonspecific spongiosis reduced pigment in epidermis no significant reduction in melanocytes Differential Vitiligo lesions fluoresce under Wood’s lamp Tinea versicolor Treatment Conservative sun protection and avoidance indication for all patients Medical topical emollients indication to decrease dryness and scaling topical therapies indications to decrease dryness and scaling to accelerate repigmentation drugs glucocorticoids calcineurin inhibitors Complications Prolonged hypopigmentation