Hypopigmented atrophic plaques in a young woman

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) …