II. Pathophysiology
- Immune-mediated Melanocyte destruction
- Family History present in up to 30% of patients
III. Epidemiology
- Affects 0.5 to 2% of the population
- Onset peaks between age 10-30 years (50% occur by age 20 years)
- Occurs equally in men and women
IV. Types
- Localized Vitiligo or Segmental Vitiligo (seen more in children)
- Stable involvement, stops progressing at a young age
- Affects a small body area or unilateral single Dermatome or extremity involved
-
Generalized Vitiligo or Nonsegmental Vitiligo
- Affects >10% of body surface area, typically bilateral and symmetric
- Progresses over time
- Acral or Acrofacial Vitiligo
- Lip-Tip pattern: Face and distal extremities
V. History
- Triggers
- Recent stress, illness or local Trauma
VI. Signs
- Sharply demarcated, white, unpigmented or hypopigmented Macules 0.5 to 5 cm in size
- May coalesce together
- More noticeable on dark skin
- Distribution
- Face and neck
- Dorsal hands
- Genitalia
- Intertriginous folds and axillae
- Periocular, periumbilical, and perianal areas
VII. Associated Conditions
VIII. Management
- Approach
- Head an neck lesions respond better to treatment than extremity and genital lesions
- Combination therapy is more effective than monotherapy, but often refractory to any treatment
- Recurrence is common (40% of cases)
- Localized Vitiligo Management
- Topical Corticosteroids, high potency, class II-III (safest and most effective localized treatment)
- Safest and most effect
- Betamethasone 0.1% ointment
- Fluocinonide 0.05% ointment
- Topical Calcineurin Inhibitors
- Surgical grafting
- May be used for localized, stable lesions
- Split thickness graft
- Suction Blister epidermal grafting
- Topical Corticosteroids, high potency, class II-III (safest and most effective localized treatment)
-
Generalized or refractory Vitiligo Management (by Dermatology)
- Narrowband Ultraviolet B or UVB (safest and most effective generalized treatment)
- Phototherapy with Psoralens or PUVA
- Systemic Corticosteroids
- Depigmentation (indicated for >40-50% of BSA involvement)
- Permanent depigmentation with Monobenzone 20% cream (no longer available in U.S.)
- Cryotherapy and laser therapy has been used as an alternative
- Requires 6-18 months for full treatment
- Cosmetic
- Concealers (e.g. Dermablend, Covermark)
- Topical dyes
- Sunless self-tanning products (skin types 2-3)
IX. Prevention
- Sun protection is critical (clothing, Sunscreen)