Differential Diagnosis for Hypopigmented Lesions Around Both Eyes
Single Most Likely Diagnosis
- Vitiligo: This is a common condition characterized by the loss of skin pigment cells (melanocytes), leading to white patches. The presence of hypopigmented lesions around the eyes for 3 years without itchiness in a 13-year-old male makes vitiligo a strong candidate, given its prevalence and the typical age of onset.
Other Likely Diagnoses
- Pityriasis Alba: A mild, chronic skin condition often seen in children and adolescents, characterized by round, oval, or irregular patches of hypopigmentation, typically on the face. It's associated with mild scaling and can be related to atopic dermatitis.
- Idiopathic Guttate Hypomelanosis: A benign condition presenting with small, discrete, hypopigmented macules, often on sun-exposed areas, but can appear elsewhere, including the face.
- Post-Inflammatory Hypopigmentation: This can occur after any inflammatory skin condition, such as eczema, psoriasis, or dermatitis, leading to areas of decreased pigmentation.
Do Not Miss Diagnoses
- Tuberous Sclerosis Complex (TSC): Although rare, TSC can present with hypopigmented macules (ash leaf spots), which are often one of the earliest signs. Given the potential severity of TSC, including neurological and renal complications, it's crucial not to miss this diagnosis.
- Neurofibromatosis Type 1 (NF1): Café-au-lait spots are a hallmark, but hypopigmented lesions can also be present. The condition has significant implications for the development of neurofibromas and other complications.
Rare Diagnoses
- Waardenburg Syndrome: A genetic disorder characterized by hearing loss, white patches of hair, and eye abnormalities, including heterochromia iridum. Hypopigmented skin patches can also be a feature.
- Piebaldism: A rare genetic condition leading to the absence of melanocytes in affected areas of skin and hair, resulting in white forelock and depigmented patches, typically on the face and trunk.