Differential Diagnosis for a 29-year-old Male with Pale Spots and White Hair

Single most likely diagnosis

• Vitiligo: This condition is characterized by the loss of skin pigment-producing cells (melanocytes), leading to pale spots. The appearance of white hair in these areas is due to the loss of melanocytes in the hair follicles as well. Vitiligo can start at any age and is often associated with autoimmune diseases.

Other Likely diagnoses

• Alopecia areata: An autoimmune condition that leads to patchy hair loss, which can sometimes be accompanied by the graying or whitening of the affected hair. While it primarily affects the scalp, it can also involve the body.
• Pityriasis alba: A mild skin condition affecting the face, characterized by small, round, pale patches. It's more common in children but can occur in adults. Hair color change is less commonly associated but can occur.
• Idiopathic guttate hypomelanosis: A benign condition characterized by small, discrete, hypopigmented spots, typically on the arms and legs. It's more common in older adults but can occur in younger individuals.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

• Systemic lupus erythematosus (SLE): An autoimmune disease that can cause a variety of skin manifestations, including pale spots and hair loss. Early diagnosis and treatment are crucial due to the potential for serious organ damage.
• Thyroid disorders: Both hypothyroidism and hyperthyroidism can cause changes in skin pigmentation and hair, including graying or whitening. These conditions require prompt diagnosis and treatment to prevent long-term complications.
• Melanoma-associated leukoderma: Although rare, it's a condition where the immune system's response to melanoma leads to the destruction of melanocytes, resulting in pale spots and potentially white hair.

Rare diagnoses

• Waardenburg syndrome: A genetic disorder characterized by hearing loss, pale skin, and hair that may be white or gray from birth. It's a rare condition but should be considered in the differential diagnosis of congenital or early-onset depigmentation.
• Chédiak-Higashi syndrome: A rare genetic disorder affecting the immune system, characterized by oculocutaneous albinism (reduced pigmentation of the skin, hair, and eyes), which could potentially present with pale spots and white hair among other symptoms.