A 48-year-old man comes to the physician because of a skin rash his girlfriend noticed on his chest and back. He is not sure how long it has been there. He is in good health and routinely takes vitamin supplements. His job is very demanding and he works out in a gym five nights a week to stay fit and alleviate stress. After his girlfriend commented on the rash he did notice that he has lately started feeling slightly itchy after working out, but did not make anything of that. He has no history of allergies to medications and the family history is negative for skin diseases. On physical examination, the patient is a muscular, fit man in no acute distress. On the sides of the neck, anterior chest, shoulders, and upper back, there are many round and oval, discrete and confluent, hypopigmented patches with a barely visible fine scale that is accentuated by rubbing. An image of the lesion is shown. The rest of the physical examination is unremarkable. Which of the following is most likely mechanism of the pigmentary change?
A. Abnormal transfer of melanosomes
B. Autoimmune destruction of melanocytes
C. Competitive inhibition of tyrosinase
D. Lysosomal defect E. Self-inflicted physical trauma
E. Self-inflicted physical trauma