Vitiligo

WhatIs ?

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WhatCauses ?

Clinical Presentations Of

Complication Of

Treatment Options For

Prevention Of

What Is Vitiligo?

Autoimmune condition that results in complete loss of skin pigmentation. It usually presents initially prior 20 years of age.

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Vitiligo
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Vitiligo
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Vitiligo
What Causes Vitiligo?
  • Either a complete or a partial lack of melanocytes due to underlying genetic predispositions
  • Non-segmental vitiligo generally thought to be an autoimmune destruction of melanocytes in genetically susceptible individuals +/- inherent defects in melanocytes or melanogenesis (production of pigment)
Clinical Presentations Of Vitiligo
  • Well demarcated white skin patches affecting any part of body part
  • Lesions tend to enlarge centrifugally
  • Sites of predilection (hyperpigmented areas): periorificial face, volar wrists, dorsal hands, nipple, axillae, umbilicus, inguinal, sacral, anogenital area
    • On extremities: elbows, knees, digits, dorsal ankles and shins
    • It commonly affects the sites which are subjected to repeated trauma, pressure or friction
    • Acrofacial: periungual (around finger nails) involvement may be associated with lip depigmentation
    • Leukotrichia (white hair) in 10-60% – always associated with depigmentation of surrounding skin
    • Vitiligo of scalp presents as localized patches of white or gray hair (poliosis)
    • Isolated early graying or whitening, <30 years of age, may represent vitiligo
  • Clinical variants:
    • Segmental vitiligo and non-segmental (vitiligo vulgaris)
    • Vitiligo ponctue: confetti like amelanotic macules +/- superimposed on a hyperpigmented macule
    • Inflammatory vitiligo: raised erythematous border
    • Blue vitiligo: develops in areas of post inflammatory hyperpigmentation
    • Trichrome vitiligo: hypopigmented zone between normal and depigmented skin
    • Quadrichrome vitiligo – a fourth darker color at sites of perifollicular re-pigmentation
    • Pentachrome vitiligo: black, dark brown, medium brown [unaffected skin], tan and white
    • Koebner phenomenon: development of vitiligo at the site of friction, surgery or scar
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Complication Of Vitiligo
  • It can be associated with ocular disease
    • Isolated uveiitis
    • Vogt Koyanagi Harada syndrome: uveitis, aseptic meningitis, otic involvement (dysacousia), head and neck vitiligo with poliosis
    • Alezzandrini – Head and Neck vitiligo, poliosis, ipsilateral decreased visual acuity & atrophic iris
  • Autoimmune condition associated with vitiligo: thyroid disease, pernicious anemia, Addison’s, Lupus, Rheumatoid Arthritis, adult onset type1 diabetes
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Treatment Options for Vitiligo
    • Principles of management: prevent further pigment loss, promote pigment gain
    • A period of 2-3 months required to determine if a given treatment is effective
    • Areas most resistant to treatment: lips and distal limbs
    • Areas most susceptible to treatment: face, neck, mid-extremities and trunk
    • First line therapies for localized vitiligo
    • First line therapy for generalized vitiligo
    • Systemic treatment
    • Excimer laser: 3 times weekly for 24-48 sessions
    • Surgical – if have the following inclusion criteria:
    • Surgical mini-grafting
    • Micropigmentation
    • Depigmentation
  • Over the counter medications
    • Regular use of moisturizers
    • Regular use of cleansers instead of moisturizers
    • Antihistamines
      • Claritin (Loratadine)
      • Cetirizine
      • Fexofenadine
      • Benadryl
  • Prescription
    • Topical medications
      • Topical steroid cream or ointment
      • Topical calcineurin inhibitors cream or ointment: Protopic or Elidel
      • Menthol or pramoxine
      • Capsaicin 0.025–0.3% every 4-6 hours
      • Topical calcipotriene
    • Phototherapy
      • Narrow Band UVB phototherapy
    • Systemic therapy
      • Selective Serotonin Reuptake Inhibitor (SSRI)
      • Tricyclic antidepressants (TCA):
      • Doxepin has anti-histamine & anti-depressant properties
      • Gabapentin or pregabalin (Lyrica)
      • Thalidomide
      • Cyclosporine
Prevention Of Vitiligo

Due to Koebner phenomenon, avoid trauma (friction, rubbing, surgery, sun burn, …) to reduce chance of developing new vitiligo patches

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Autoimmune condition that results in complete loss of skin pigmentation. It usually presents initially prior 20 years of age.