Differential Diagnosis for Fleshy Shiny Hypopigmented Patches of the Scalp and Neck

• Single Most Likely Diagnosis
  • Pityriasis versicolor: This condition is characterized by hypopigmented or hyperpigmented patches on the skin, often with a shiny appearance, and is commonly found on the scalp, neck, and upper body. The fleshy appearance might be due to the inflammatory component of the disease.
• Other Likely Diagnoses
  • Seborrheic dermatitis: While typically associated with erythema and scaling, some forms of seborrheic dermatitis can present with hypopigmentation, especially in darker-skinned individuals. The scalp and neck are common areas of involvement.
  • Tinea versicolor (pityriasis versicolor in its early stages): Similar to the single most likely diagnosis but considering the possibility of it being in an early stage or having a slightly different presentation.
  • Vitiligo: Although typically characterized by completely depigmented patches, early stages or certain types of vitiligo might present with hypopigmentation and could be considered, especially if the patches are not completely devoid of pigment.
• Do Not Miss Diagnoses
  • Sarcoidosis: This systemic disease can cause skin lesions, including hypopigmented patches, and is crucial to diagnose due to its potential for serious systemic involvement, including lung and eye disease.
  • Leprosy (Hansen's disease): A chronic infection that can cause hypopigmented skin patches, among other symptoms. Early diagnosis is critical to prevent long-term disability.
• Rare Diagnoses
  • Piebaldism: A rare genetic condition characterized by the absence of melanocytes in affected areas of skin and hair, leading to white forelock and depigmented patches, typically on the scalp and face.
  • Waardenburg syndrome: Another genetic disorder that affects the development of melanocytes, leading to patches of depigmentation and other systemic features like deafness and eye abnormalities.
  • Idiopathic guttate hypomelanosis: A condition of unknown cause characterized by small, discrete, hypopigmented macules, typically on the extremities but can occasionally be found on the scalp and neck.