II. Pathophysiology

  1. Immune-mediated Melanocyte destruction
  2. Family History present in up to 30% of patients
  3. Occurs equally in men and women

III. Epidemiology

  1. Affects 1% of the population
  2. Onset peaks between age 10-30 years (50% occur by age 20 years)

IV. Types

  1. Generalized Vitiligo (>10% of body surface area involved)
  2. Acral or Acrofacial Vitiligo (tip-lip pattern: face and distal extremities)
  3. Localized Vitiligo (stable involvement of a small body area)
  4. Segmental Vitiligo (single dermatome or extremity involved - seen more in children)

V. Signs

  1. Sharply demarcated, white, unpigmented Macules 0.5 to 5 cm in size
  2. Distribution
    1. Face and neck
    2. Dorsal hands
    3. Genitalia
    4. Intertriginous folds and axillae
    5. Periocular, periumbilical, and perianal areas

VI. Management: General

  1. Sun protection is critical (clothing, Sunscreen)

VII. Management: Cosmetic

  1. Concealers (e.g. Dermablend)
  2. Topical Corticosteroids
    1. Class II-III Topical Corticosteroids (e.g. Betamethasone 0.05% ointment or cream)
  3. Phototherapy with Psoralens (PUVA)
  4. Depigmentation (indicated for >40% of BSA involvement)
    1. Permanent depigmentation with Monobenzone 20% cream
    2. Requires 6-18 months for full treatment
  5. Surgical grafting
    1. May be used for localized, stable lesions

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Ontology: Vitiligo (C0042900)

Definition (CHV) A condition in which the skin turns white due to the loss of melanocytes
Definition (MEDLINEPLUS)

Vitiligo causes white patches on your skin. It can also affect your eyes, mouth, and nose. It occurs when the cells that give your skin its color are destroyed. No one knows what destroys them. It is more common in people with autoimmune diseases, and it might run in families. It usually starts before age 40.

The white patches are more common where your skin is exposed to the sun. In some cases, the patches spread. Vitiligo can cause your hair to gray early. If you have dark skin, you may lose color inside your mouth.

Using sunscreen will help protect your skin, and cosmetics can cover up the patches. Treatments for vitiligo include medicines, light therapy, and surgery. Not every treatment is right for everyone. Many have side effects. Some take a long time. Some do not always work.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Definition (NCI) Generalized well circumscribed patches of leukoderma that are generally distributed over symmetric body locations and is due to autoimmune destruction of melanocytes.(NICHD)
Definition (MSH) A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached.
Definition (CSP) usually progressive, chronic pigmentary anomaly of the skin manifested by depigmented white patches that may be surrounded by a hyperpigmented border.
Concepts Disease or Syndrome (T047)
MSH D014820
ICD9 709.01
ICD10 L80
SnomedCT 156437000, 56727007
LNC LA15163-1
French VITILIGO, Vitiligo
English VITILIGO, vitiligo, vitiligo (physical finding), Vitiligo [Disease/Finding], Vitiligo, Hypopigmentation of skin, Vitiligo (disorder)
Portuguese VITILIGO, Vitiligo
Spanish VITILIGO, Vitíligo, vitiligo (trastorno), vitiligo
German VITILIGO, Vitiligo
Italian Vitiligine
Japanese 尋常性白斑, ジンジョウセイハクハン
Swedish Vitiligo
Czech Vitiligo
Korean 백반증
Polish Bielactwo nabyte
Hungarian Vitiligo
Dutch vitiligo, Vitiligo