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Ted Rosen, MD: Potential Reasons for Misdiagnosis of White Spots as Vitiligo

A discussion with Dr. Rosen on one of his SPDA 2022 presentations, highlighting his reason for choosing the topic and exploring vitiligo misdiagnosis.

During an interview with HCPLive regarding a presentation at the SDPA 20th Annual Fall Dermatology Conference, Ted Rosen, MD, discussed the inspiration for his topic on non-vitiligo white spots on the skin.

Rosen serves as Professor and Vice-Chair of Dermatology at Baylor College of Medicine. His presentation ‘It's not always Vitiligo’ explained some of the potential reasons why skin, specifically skin of color, may assume a pathologic white tone besides vitiligo.

“My inspiration for choosing to speak on this topic was because it's so important to develop a comprehensive differential diagnosis of what can cause white spots on dark skin,” he explained. “Without that comprehensive differential, one could very easily miss the proper diagnosis and administer not only the wrong therapy, but treatment that might actually be disadvantageous, or problematic.”

Rosen touched on several of the diagnostic possibilities as well as whether or not it is common for vitiligo to be incorrectly diagnosed in a patient.

“So there are a lot of different diagnostic possibilities when you see white spots on dark skin. And you might broadly classify them into common things that can mimic vitiligo, uncommon, and very important things that can mimic vitiligo, and then what I would consider to be uncommon, even rare things that can meet a vertical vitiligo,” he explained.

According to Rosen, a biopsy may be an ideal way in certain cases to determine the root cause of white spots on the skin appearing similar to vitiligo.

“In the broadest sense, the easiest way to make a diagnosis or rule out some diagnoses is to do a biopsy,” he said. “Remember, biopsy is how we often arrive at the correct diagnosis and we should never be inhibited doing that regardless of the anatomic site where the abnormality is. Sometimes special stains on that biopsy are necessary. Sometimes one might need to do a scraping or a culture.”

Rosen’s full presentation at the conference featured a discussion of mundane and rare diseases and disorders with white spot presentation, helping participants to construct a broad differential diagnosis for white skin spots and learn more about the appropriate diagnostic maneuvers or interventions for such cases.

View the full interview segment above from Rosen’s SDPA 2022 Conference presentation coverage.