Friday Pop Quiz #255

The correct answer is E. Trial of potent topical corticosteroid.

Recognize the well-defined irregularly-bordered patches and macules on the
face as most consistent with vitiligo. Initial recommendations for repigmentation should include topical corticosteroids. Most likely, this should
be performed with potent topical corticosteroids rather than a retrial of
hydrocortisone 1% cream, which is likely not strong enough for

Initiation of narrowband UVB light therapy is first-line for widespread or rapidly progressive disease, though it may not be as useful as a topical first-line therapy in a treatment algorithm. A fungal scraping would be useful for
diagnostic certainty, though given the patient’s lack of morphologic findings
consistent with a fungal infection, vitiligo remains a strong clinical diagnosis.
Suction blister epidermal grafting can be performed for excellent
repigmentation, though appropriate topical therapies should be trialed first;
thus, repeating the hydrocortisone would not be an effective option.


Seneschal J, Speeckaert R, Taïeb A, et al. Worldwide expert recommendations
for the diagnosis and management of vitiligo: Position statement from the
international Vitiligo Task Force-Part 2: Specific treatment recommendations
[published online ahead of print, 2023 Sep 15]. J Eur Acad Dermatol Venereol.