Vitiligo

Notes

## Basic introduction

  • This is chronic acquired discoloration of the skin and mucus membranes that is characterized by loss of skin melanocytes

## Cause(s)

  • It is a disease of unknown etiology
  • It is however thought to be caused by:

_Autoimmune destruction of melanocytes

_Functional defects of melanocytes

_Autotoxic factors

_Genetic factors

## Risk factors

  • Family history of the disease
  • Other autoimmune diseases that may include:

_Hyperthyroidism

_Alopecia areata

_Pernicious anemia

## Statistics

  • It affects up to 1-2% of the global population
  • The prevalence of occurrence of vitiligo lesion in areas of trauma (Koebnerization) has been found to be about 28.7% in Tanzania

## Classification

It is classified as:

  • Segmental (involving one side of the body)
  • Non-segmental (showing some form of symmetry)

_Acrofacial

_Generalized

_Universal

_Mucosal

Symptoms
  • Skin depigmentation of varying extent
  • Itching and burning sensation, mainly prior to the onset of the lesion
  • Lesions enlarge centrifugally with time and at an unpredictable speed
Diagnosis
  • Clinical review, especially skin examination
  • UV light (when exposed to a black light, the affected skin will glow blue)
  • Microscopic examination of involved skin shows a complete absence of melanocytes
  • Biopsy
Differential
  • Albinism
  • Idiopathic guttate hypomelanosis
  • Piebaldism
  • Pityriasis alba
  • Post-inflammatory hypopigmentation
  • Primary adrenal insufficiency
  • Progressive macular hypomelanosis
  • Tinea versicolor
  • Tuberculoid leprosy
Prevention
  • None is known
Reference

1. Ezzedine, K; Eleftheriadou, V; Whitton, M; van Geel, N (4 July 2015). "Vitiligo.". Lancet (London, England). 386 (9988): 74–84.

2. Whitton, ME; Ashcroft, DM; González, U (Oct 2008). "Therapeutic interventions for vitiligo.". Journal of the American Academy of Dermatology. 59 (4): 713–7.

Management
  • There is no known cure for vitiligo
  • Treatment with topical corticosteroids (that is mostly combined with tacrolimus and other calcineurin inhibitors) is usually the 1st line treatment
  • Narrowband ultraviolet B (NBUVB) or Psoralen and Ultra Violet A (PUVA) that is administered 2 to 3 times a week for 6-12 months

_Vitiligo on the neck and face that have been in existence for < 3yrs takes few weeks to treat

_Vitiligo on the hands and legs that have been in existence for >3yrs takes months to treat

_Psoralens are meant to increase the skin's sensitivity to UV in order to improve the treatment outcome but care should be taken as it can cause sunburn-type reactions and skin freckling when administered excessively.

_NBUVB treatment is an alternative to PUVA that has the benefit of causing less side-effects while it is as effective as PUVA

  • In case of widespread pigment loss, residual patches of normal skin is bleached with monobenzyl ether of hydroquinone
  • Skin camouflage
  • Surgical skin-grafting
  • Counselling to provide emotional support
Drug Index 2.0 is here
Our new update features a more powerful search feature and easier login. Having any issues? Contact us today. Contact Us