Diagnosis

Vitiligo

Etiology

Cause [mh9][ub2]

• Autoimmune disorder of unknown cause - possibly an error of immune surveillance

• Genetic factors

• Environmental factors

Pathophysiology [ub2]

1. Melanocytes are selectively destroyed --> absence of melanocytes --> depigmentation

2. Theories of melanocyte destruction: cytotoxic mechanisms, intrinsic melanocyte defects, neural mechanisms, and oxidant-antioxidant mechanisms

3. Associated with thyroid abnormalities

4. Clinical presentation:

   • Trichrome

   • Marginal inflammatory

   • Quadrichrome

   • Koebner phenomenon

   • Localization:

     • Hands

     • Forearms

     • Feet

     • Face: periocular or perioral distribution

5. Classification:

   • Generalized

   • Segmental

   • Localized

Complications [mh9]

• Autoimmune thyroid disease

• Rheumatoid arthritis

• Diabetes mellitus

• Alopecia areata

• Addison disease

• Atopic dermatitis

• Urticaria

• Hypoparathyroidism

• Ichthyosis

• Pernicious anemia

• Psoriasis

Epidemiology

Incidence per 100.000 [ovs][ydy][mh9]

Approach

• Dermatoscopy

• Wood´s lamp: a hanheld UV irradiation device [mh9]

• Confocal microscopy

• Biopsy

• Blood test: thyroid function

Treatment

1. Spontaneous repigmentation may occur but is uncommon [mh9]

2. Topical: corticosteroids, calcineurin inhibitors, and vitamin D analogs [ub2]

3. Phototherapy: UV-B 2-3/week induces repigmentation in early disease

4. Laser therapy: Excimer Laser to treat limited, stable patches of vitiligo

5. Systemic: if resistant disease, tacrolimus and systemic corticosteroids

6. Surgical repigmentation: if segmental/localized disease [ub2]

   • Non cultured epidermal suspensions

   • Thin dermo-epidermal grafts

   • Suction epidermal grafts

   • Punch grafting

   • Cultured epidermis with melanocytes

Differential diagnoses

Adrenal insufficiency, Alezzandrini Syndrome, Cutaneous T-cell lymphoma, Drug eruptions, Eczema, Idiopathic guttate hypomelanosis, Leishmaniasis, Leporsy, Leprosy, Leukoderma, Lichen sclerosus, Lichen striatus, Malignant melanoma, Mycosis fungoides, Nevus, Nevus anemicus, Onchocerciasis, Piebaldism, Pityriasis alba, Pityriasis versicolor, Psoriasis, Systemic lupus erythematosus, Systemic sclerosis, Treponematosis, Tuberous sclerosis, Vogt-Koyanagi-Harada syndrome, Waardenburg syndrome