Widespread hypopigmented ...

An Afro–Caribbean boy first presented with widespread hypopigmented patches with fine scaling over his trunk, limbs, buttocks, and neck at six. His skin biopsy confirmed a diagnosis of Stage 1B CD8+ hypopigmented mycosis fungoides. Human T‐lymphotropic virus type 1 and 2 screening and lymphocyte subsets were negative or normal. At 14, he tolerated oral PUVA with a total dose of 173.5 J, achieving a good response with no reported side effects from the treatment. 

Eighteen months later, he had a recurrence of hypopigmented patches on his lower legs, gluteal fold, and arms and was again treated with cabinet PUVA phototherapy with oral 5‐methoxy psoralen. Three weeks after, he developed Onycholysis. He was on no systemic medication, and thyroid function tests were routine. He was treated for a phototoxic reaction to PUVA with clobetasol propionate scalp application dribbled under the nail's free edge daily. After a month, he reported that the discomfort had resolved.