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Table of Contents 
Year : 2011  |  Volume : 56  |  Issue : 3  |  Page : 341-342
Asymptomatic papules and plaque in a patient with generalized vitiligo

1 Department of Dermatology, Apollo Hospitals, Hyderabad, India
2 Department of Pathology, Apollo Hospitals, Hyderabad, India

Date of Web Publication30-Jun-2011

Correspondence Address:
I S Reddy
B-13 Madura Nagar, S.R. Nagar Post, Hyderabad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.82506

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How to cite this article:
Reddy I S, Swarnalatha G, Swain M. Asymptomatic papules and plaque in a patient with generalized vitiligo. Indian J Dermatol 2011;56:341-2

How to cite this URL:
Reddy I S, Swarnalatha G, Swain M. Asymptomatic papules and plaque in a patient with generalized vitiligo. Indian J Dermatol [serial online] 2011 [cited 2023 Sep 24];56:341-2. Available from:

A 40-year-old house-wife presented with multiple, asymptomatic, discrete, brownish-yellow, verrucous papules over the back of the hands, forearms [Figure 1] and upper back since three years and a solitary, ill-defined, scaly and crusted plaque over the back of the left fore arm since one year. [Figure 2] The removal of the crust revealed erythematous bleeding surface. Patient has generalized vitiligo since childhood which was treated with ayurvedic medicines. The totally depigmented skin over the sun-exposed areas started developing multiple, brownish macules and patches since four-five years. Patient denied having taken neither topical, oral medication nor phototherapy for vitiligo. There was no history of exposure to ionizing radiation. Patient had a chronic non healing ulcer over the back of the right forearm, biopsy of which showed well-differentiated squamous cell carcinoma. The ulcer was excised few months ago. The clinical photographs of the verrucous papules and plaque over the left fore arm and the corresponding biopsy [Figure 3] and [Figure 4] are shown below.
Figure 1: Back of the left forearm and hand showing multiple papules

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Figure 2: Back of the left forearm showing the plaque

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Figure 3: H/P of the papule showing marked parakeratosis, absence of granular layer and complete loss of orderly arrangement of keratinocytes throughout the entire thickness of the epidermis. (H and E ×200)

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Figures 4: The plaque showing significant parakeratosis and crusting, prominent and irregular acanthosis, papillomatosis, full thickness atypia of epidermis, dysplastic changes in the infundibular portion of the hair follicle and intact basal layer, (H and E ×100/200)

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   Question Top

What is your diagnosis?

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   References Top

1.Schwartz RA, Stoll HL Jr. Epithelial precancerous lesions. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, editors. Dermatology in general medicine. 4 th ed. Newyork: Mc Graw Hill; 1993. p. 804-21  Back to cited text no. 1
2.Salasche SJ. Epidemiology of actinic keratoses and squamous cell carcinoma. J Am Acad Dermatol 2000;42:S4-7.  Back to cited text no. 2
3.Kirkham N. Tumors and cysts of the epidermis. In: Elder DE, Elenitsas R, Murphy GF, Johnson BL Jr, Xu X, editors. Histopathology of the skin. 10 th ed. Philadelphia: Lippincott William and Wilkins; 2009. p. 791-841  Back to cited text no. 3
4.Mehta NR, Shah KC, Theodore C, Vyas VP, Patel AB. Epidemiologic study of vitiligo in Surat area, South Gujarat. Indian J Med Res1973;61:145-54.  Back to cited text no. 4
5.Bleehen SS, Anstey AV. Disorders of skin colour. In: Burns T, Breathnach S, Cox N, Griffith C, editors. Rooks Text book of dermatology. 7 th ed. Oxford: Blackwell Science; 2004. P.39.1-39.68.  Back to cited text no. 5
6.Gloster HM Jr, Neal K. Skin cancer in skin of colour. J Am Acad Dermatol 2006;55:741-60.  Back to cited text no. 6
7.Takeda H, Mitsuhashi Y, Kondo S. Multiple squamous cell carcinoma in situ in vitiligo lesions after long- term PUVA therapy. J Am Acad Dermatol 1998;38:268-70.  Back to cited text no. 7
8.Seo SL, Kim IH. Squamous cell carcinoma in a patient with generalized vitiligo. J Am Acad Dermatol 2001;45:S227-9.  Back to cited text no. 8
9.Hexsel CL, Eide MJ, Johnson CC, Krajenta R, Jacobsen G, Hamzavi I, et al. Incidence of non melanoma skin cancer in a cohort of patients with vitiligo. J Am Acad Dermatol 2009;60: 929-33  Back to cited text no. 9


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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