A Woman with Progressive Diffuse Symmetric Hyper and Hypopigmentation

A 40-year-old woman presented with progressive diffuse symmetric spotted hypopigmentation on non-atrophic hypopigmented macules, that appeared firstly on the face, developing over 4 years. The lesion was mildly itchy, but no pain. Patient had no history of significant medical problems or disease. She denied using any long-term medications, topical creams, or preparations before the onset of the skin changes (Figs. 28.1 and 28.2).