Dermatology

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Vitiligo

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a pigmentation disorder of unknown etiology in which melanocytes in the affected skin and mucous membranes are destroyed

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Vitiligo

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This destruction is thought to be caused by an autoimmune process because patients with vitiligo have a high incidence of antibodies to melanocytes.

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Vitiligo

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Vitiligo affects approximately 1% of the world’s population.[2]Furthermore, approximately 30% of vitiligo patients have a positive family history of the disorder.

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Vitiligo

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Depigmentation can begin in childhood, and more than 75% of patients present before 30 years of age

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Vitiligo

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The disease is characterized by sharply demarcated, depigmented, nonscaly round or oval macules and patches on the skin and mucous membranes that range from a few millimeters to several centimeters in size

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Vitiligo

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a pigmentation disorder of unknown etiology in which melanocytes in the affected skin and mucous membranes are destroyed

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Vitiligo

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This destruction is thought to be caused by an autoimmune process because patients with vitiligo have a high incidence of antibodies to melanocytes.

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Vitiligo

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Vitiligo affects approximately 1% of the world’s population.[2]Furthermore, approximately 30% of vitiligo patients have a positive family history of the disorder.

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Vitiligo

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Depigmentation can begin in childhood, and more than 75% of patients present before 30 years of age

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Vitiligo

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The disease is characterized by sharply demarcated, depigmented, nonscaly round or oval macules and patches on the skin and mucous membranes that range from a few millimeters to several centimeters in size

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Vitiligo

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a pigmentation disorder of unknown etiology in which melanocytes in the affected skin and mucous membranes are destroyed

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Vitiligo

Back 12

This destruction is thought to be caused by an autoimmune process because patients with vitiligo have a high incidence of antibodies to melanocytes.

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Vitiligo

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Vitiligo affects approximately 1% of the world’s population.[2]Furthermore, approximately 30% of vitiligo patients have a positive family history of the disorder.

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Vitiligo

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Depigmentation can begin in childhood, and more than 75% of patients present before 30 years of age

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Vitiligo

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The disease is characterized by sharply demarcated, depigmented, nonscaly round or oval macules and patches on the skin and mucous membranes that range from a few millimeters to several centimeters in size

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Vitiligo

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The condition is usually nonerythematous. The initial lesions occur most commonly on sun-exposed areas, such as the face, forearms, and dorsal surfaces of the hands and feet.

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Vitiligo

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Vitiligo has a periorificial predilection, with areas around the mouth, nose, eyes, nipples, umbilicus and anus commonly being affected

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Vitiligo

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The axillae and genitalia are also commonly involved. Vitiligo may also develop at sites of trauma, such as cuts or burns (Koebner phenomenon).

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Vitiligo

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Sweating is increased in the depigmented areas while there may also be leukotrichia or depigmentation of the scalp hair, eyebrows, eyelashes, beard, and pubic hair. Patients with segmental vitiligo and poliosis usually do not have associated autoimmune diseases.

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Vitiligo

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Vitiligo can be classified as localized, generalized, or universal. Patients with localized vitiligo have unilateral areas of depigmentation limited to one part of the body (such as one side of the face or one limb).

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Vitiligo

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These lesions may have a dermatomal-like distribution pattern and, although vitiligo is usually chronic and progressive, in some patients with segmental vitiligo the hypopigmented macules and patches remain localized and do not spread.

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Vitiligo

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Patients with generalized vitiligo have widely distributed depigmented macules and patches, usually on both sides of the body.

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Vitiligo

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This is the most common pattern and the lesions may either be symmetrical or asymmetrical. Patients with universal vitiligo have total or near-total depigmentation of their skin

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Vitiligo

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Trichrome vitiligo, in which patients have three zones of different colors; these range from the central achromic zone, to its surrounding hypochromic zone, to the outermost peripheral normal colored skin zone

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Vitiligo

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Quadrichrome vitiligo, in which there is a fourth dark color in areas undergoing perifollicular hyperpigmentation

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Vitiligo

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Pentachrome vitiligo, with five zones of different colors

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Vitiligo

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Blue vitiligo, in which patients with postinflammatory hyperpigmentation develop blue vitiliginous macules

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Vitiligo

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Inflammatory vitiligo, in which an erythematous border surrounds the vitiliginous area

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Vitiligo

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In addition to the dermatologic effects, vitiligo tends to have an emotional and psychological impact. Patients with vitiligo, particularly adolescents who have dark skin types, can experience emotional stress, develop low self-esteem, stigmatization, social anxiety, and even depression. This is especially true if the depigmented patches are on the genitals or on highly visible areas, such as the face and hands.

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Vitiligo

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A skin biopsy can help differentiate vitiligo from other hypopigmented lesions because it demonstrates a complete absence of melanocytes in the affected skin.

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Vitiligo

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Useful laboratory tests can include a complete blood cell count, thyroid function tests, urea and electrolytes, a fasting blood glucose test, vitamin B12 levels, antinuclear antibodies, antithyroglobulin, and antiparietal cell antibodies.

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Vitiligo

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Patients with vitiligo have an increased incidence of Graves disease, Hashimoto thyroiditis, Addison’s disease, alopecia areata, diabetes mellitus, pernicious anemia, and other autoimmune diseases.

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Vitiligo

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The differential diagnosis of vitiligo includes idiopathic guttate hypomelanosis, tinea versicolor, halo nevus, leprosy, postinflammatory hypopigmentation, pityriasis alba, tuberous sclerosis, nevus depigmentosus, chemical leukoderma, and piebaldism.

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Vitiligo

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the treatment of vitiligo is challenging because no single treatment results in the repigmentation of all patients.

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Vitiligo

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1) topical corticosteroids, 2) topical calcineurin inhibitors; 3) Vitamin D analogues; 4) narrow-band ultraviolet B (UV-B) light therapy;

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Vitiligo

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5) Topical psoralen ointment with ultraviolet A light therapy (PUVA) or topical psoralen photochemotherapy; 6) Oral psoralen with ultraviolet A light therapy (PUVA) or systemic psoralen photochemotherapy;

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Vitiligo

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Laser therapy with a 308 nm excimer laser; and 8) Depigmentation of normal surrounding skin with p-(benzyloxy) phenol, which is the monobenzyl ether of hydroquinone (MBEH).

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Vitiligo

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Topical PUVA, corticosteroids, and calcineurin inhibitors are used to treat patients with a few localized patches of vitiligo.

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Vitiligo

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Oral PUVA is usually reserved for patients with vitiligo affecting more than 20% of their skin surface area, laser therapy is used when less than 30% of the skin is involved, and p-(benzyloxy) phenol is used to treat patients with extensive vitiligo affecting more than 50% of their skin, as it will depigment normal, unaffected skin.

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Vitiligo

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The safest and most effective of the medical therapies for vitiligo are class 3 topical corticosteroids and ultraviolet B (UV-B) therapy.[2] Narrow band ultraviolet B (UV-B) therapy is superior even to oral PUVA in treating nonsegmental vitiligo.

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Vitiligo

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Split skin grafting is the best surgical option whereas minigrafting has the most adverse effects (which include a cobblestone appearance in over 25% of patients).

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Vitiligo

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Broad spectrum sunscreens that offer protection from ultraviolet A (UV-A) and ultraviolet B (UV-B) light and a sun protection factor (SPF) of 15 or higher should be used because the depigmented lesions are at increased risk for sunburn and subsequent skin cancers.

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Vitiligo

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Patients should also be advised to wear protective clothing and minimize sun exposure. Camouflage cosmetics, which include makeup, dyes and self-tanning lotions, are also beneficial.

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Vitiligo

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Psychological treatments, including cognitive therapy and counseling, are important because they improve the coping mechanisms of patients with vitiligo.

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Vitiligo

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Patient support groups are useful for enhancing emotional well-being. The parents of children with vitiligo should also receive counseling