Dermatology Book



Aka: Vitiligo
  1. Pathophysiology
    1. Immune-mediated Melanocyte destruction
    2. Family History present in up to 30% of patients
  2. Epidemiology
    1. Affects 0.5 to 2% of the population
    2. Onset peaks between age 10-30 years (50% occur by age 20 years)
    3. Occurs equally in men and women
  3. Types
    1. Localized Vitiligo or Segmental Vitiligo (seen more in children)
      1. Stable involvement, stops progressing at a young age
      2. Affects a small body area or unilateral single dermatome or extremity involved
    2. Generalized Vitiligo or Nonsegmental Vitiligo
      1. Affects >10% of body surface area, typically bilateral and symmetric
      2. Progresses over time
    3. Acral or Acrofacial Vitiligo
      1. Lip-Tip pattern: Face and distal extremities
  4. History
    1. Triggers
      1. Recent stress, illness or local Trauma
  5. Signs
    1. Sharply demarcated, white, unpigmented or hypopigmented Macules 0.5 to 5 cm in size
      1. May coalesce together
    2. More noticeable on dark skin
    3. Distribution
      1. Face and neck
      2. Dorsal hands
      3. Genitalia
      4. Intertriginous folds and axillae
      5. Periocular, periumbilical, and perianal areas
  6. Associated Conditions
    1. Thyroid disease (Hypothyroidism, Hyperthyroidism)
    2. Pernicious Anemia
    3. Diabetes Mellitus
  7. Management
    1. Approach
      1. Head an neck lesions respond better to treatment than extremity and genital lesions
      2. Combination therapy is more effective than monotherapy, but often refractory to any treatment
      3. Recurrence is common (40% of cases)
    2. Localized Vitiligo Management
      1. Topical Corticosteroids, high potency, class II-III (safest and most effective localized treatment)
        1. Safest and most effect
        2. Betamethasone 0.1% ointment
        3. Fluocinonide 0.05% ointment
      2. Topical Calcineurin Inhibitors
        1. Tacrolimus (Protopic)
        2. Pimecrolimus (Elidel)
      3. Surgical grafting
        1. May be used for localized, stable lesions
        2. Split thickness graft
        3. Suction Blister epidermal grafting
    3. Generalized or refractory Vitiligo Management (by Dermatology)
      1. Narrowband Ultraviolet B or UVB (safest and most effective generalized treatment)
      2. Phototherapy with Psoralens or PUVA
      3. Systemic Corticosteroids
      4. Depigmentation (indicated for >40-50% of BSA involvement)
        1. Permanent depigmentation with Monobenzone 20% cream (no longer available in U.S.)
        2. Cryotherapy and laser therapy has been used as an alternative
        3. Requires 6-18 months for full treatment
    4. Cosmetic
      1. Concealers (e.g. Dermablend, Covermark)
      2. Topical dyes
      3. Sunless self-tanning products (skin types 2-3)
  8. Prevention
    1. Sun protection is critical (clothing, Sunscreen)
  9. References
    1. Njoo (1999) Arch Dermatol 135(12):1514-21 [PubMed]
    2. Plensdorf (2017) Am Fam Physician 96(12): 797-804 [PubMed]
    3. Plensdorf (2009) Am Fam Physician 79(2): 109-16 [PubMed]

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
Derived from the NIH UMLS (Unified Medical Language System)

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