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Endgames Spot Diagnosis

Hypopigmented atrophic plaques in a young woman

BMJ 2021; 373 doi: (Published 05 May 2021) Cite this as: BMJ 2021;373:n1012
  1. Prateek Sharma, postgraduate trainee (dermatology),
  2. V Ramesh, professor of dermatology
  1. Department of Dermatology, Safdarjung Hospital, New Delhi, India
  1. Correspondence to: P Sharma prateeiik{at}

A woman in her 20s presented to dermatology clinic with a four year history of a mildly itchy hypopigmented patch in her natal cleft, and similar itchy lesions that had gradually appeared on the back of both knees over the past six months (fig 1, fig 2). The lesions ranged from white to brown.

Fig 1

Hypopigmented atrophic plaques in upper part of natal cleft

Fig 2

Hypopigmented atrophic plaques in popliteal fossae

Treatment with topical antifungal creams for suspected candidal intertrigo was unsuccessful.

Cutaneous examination revealed multiple ill defined hypopigmented plaques in the upper part of the natal cleft and both popliteal fossae. On close inspection, the affected skin showed fine wrinkling and increased translucency (not clear in the figure) …

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