Skin Health
Case Studies: Mistaken Psoriasis & Vitiligo, Plant-Induced Photocontact Dermatitis
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Ace Skinvestigators

Think dermatologists are just Botox® and beauty? What some of them are capable of may surprise you. We shine the light on the dermatologist mystery solvers, complicated disease managers, and life savers.

All names and some details that could allude to patients’ and doctors’ identities have been changed to protect their privacy. In the collection of these case studies, no patient names were disclosed. These articles are intended for informational purposes only, to share interesting real-life dermatology cases—they should not be relied on for diagnostic accuracy or applicability to your particular skin, which requires an in-person ocular consultation with a qualified physician. For appropriate care for your skin, please consult your dermatologist.

Case 1: Syphilis Mistaken For Psoriasis

By the time John, a teenager, was referred to Dr. Smith, he had been unsuccessfully treated for psoriasis by two other dermatologists. Dr. Smith was a specialist in the disease and thought something was amiss—the symptoms, history and response to therapy did not seem to fit a diagnosis of psoriasis. She asked John’s parents if they would allow her to speak with John alone for a few minutes. In private, Dr. Smith asked John questions that he may have been uncomfortable answering in front of his parents, including whether he ever had unprotected sex. After a biopsy, Dr. Smith confirmed that John had syphilis. Without therapy, the many risks included blindness, mental illness, paralysis and other debilitating symptoms (to John) and a spread of the disease (to others).

Case 2: Expanded, Non-Standard Testing

Dr. Smith had another “psoriasis” referral in Steve. Because his condition was so problematic, Dr. Smith interviewed him in great detail and decided to explore the possibility of other conditions. Based on several of his answers, Dr. Smith ordered some non-standard tests. These revealed that Steve’s presenting problem was just part of a more serious condition: he was HIV-positive. In addition to changing his therapy, he was quickly referred to a specialist—while Dr. Smith remains a consult for his skin concerns, he was able to get early intervention and more targeted management of the underlying condition.

Case 3: Unmasking “Vitiligo

In a less life-threatening case, Jill, a laboratory employee, was diagnosed with vitiligo. In this disease, melanocytes (skin cells that produce pigment) die, leaving patches of unnaturally white skin.

Jill saw several dermatologists in different countries before finally seeking out Dr. Perez, a well-known expert in vitiligo. Noticing that the whiteness was isolated to the skin around Jill’s eyes, Dr. Perez expanded the scope of his questioning, eventually honing in on some aspects of Jill’s job.

Dr. Perez ordered a biopsy (which had not been done but should have) as well as some tests not usually ordered when vitiligo is suspected. The tests proved that Jill did not have vitiligo but in fact was highly allergic to rubber. During the interview, Dr. Perez learned that at her workplace, Jill used protective goggles lined with rubber, a common allergen. It was because Dr. Perez took the time to expand his inquiry that he began to suspect an allergic reaction.

Case 4: Plant Perpetrator

In Maria’s case, the diagnosis and therapy were correct. She had severe melasma and her physician gave her effective treatments. Still, nothing worked. Luckily Dr. Hunter, a detective-like dermatologist, kept exploring. Wanting to rule out a sensitivity to chemical (also called “organic”) sunscreens, he insisted on a photo-patch test. The test was negative for organic sunscreens, but showed that Maria, an avid gardener, was allergic to chemicals inherent to many household plants. The melasma cleared with the same therapy and with Maria enjoying her plants from a distance.

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Click here to learn more about the VH-Rating System.

Click here for information about patch tests.