<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:An otherwise healthy 17-year-old girl comes to the physician because of multiple patches on her face, hands, abdomen, and feet that are lighter than the rest of her skin. The patches began to appear 3 years ago and have been gradually increasing in size since. There is no associated itchiness, redness, numbness, or pain. She emigrated from India 2 years ago. An image of the lesions on her face is shown. Which of the following is most likely involved in the pathogenesis of this patients skin findings?? A: Absence of tyrosinase activity, B: Infection with Mycobacterium leprae, C: Infection with Malassezia globosa, D: Defective tuberin protein, E: Autoimmune destruction of melanocytes,  <response>: This is a clinical vignette describing a 17-year-old girl with hypopigmented skin patches on her face, hands, abdomen and feet that have been gradually enlarging over the past 3 years. She is otherwise healthy and the lesions are asymptomatic. The image shows hypopigmented macules on the face in a symmetrical distribution. Based on the clinical history and description, this presentation is most consistent with vitiligo. The key features are asymptomatic hypopigmented patches in a symmetrical distribution that have been gradually enlarging over time. The question asks to identify the pathogenesis most likely involved. Vitiligo is caused by autoimmune destruction of melanocytes, resulting in depigmented patches due to loss of melanin production.Therefore, the answer is likely autoimmune destruction of melanocytes. The other options can be ruled out:A Absence of tyrosinase activity would cause oculocutaneous albinism, not vitiligo. B Infection with Mycobacterium leprae causes leprosy, which has a different presentation.C Infection with Malassezia globosa may cause pityriasis versicolor, which also looks different.D Defective tuberin protein causes tuberous sclerosis, an unrelated condition.In summary, vitiligo is the most likely diagnosis based on the clinical presentation, and it is caused by autoimmune destruction of melanocytes.E: Autoimmune destruction of melanocytes 