Vitiligo

General Information

Classification: Integumentary
Figure 1 White/depigmented macules characteristic of vitiligo

What is it?

Acquired, primary autoimmune depigmentation with no secondary cause

Risk Factors: *thyroid disease or abnormalities, Addison’s disease, Type 1 Diabetes Mellitus, family history

Classification

  • Clinical variants: trichrome, marginal inflammatory, quadrichrome, leukotrichia
    • Trichrome: 3 shades (normal, hypopigmentation, depigmentation)
    • Marginal inflammatory: erythematous borders
    • Quadrichrome: 4 shades (trichrome but with hyperpigmented rim)
    • Leukotrichia: white hair in patch (Figure 2)
  • Pattern distribution: generalized/vulgaris, segmental, localized/focal, universal
    • Vulgaris: most common distribution
    • Segmental: unilateral, dermatomal, stable, early-onset
    • Focal: isolated and localized patches
    • Universal: 80-90% of body is depigmented

Evaluation

Signs & Symptoms

  • White macules and patches that tend to be symmetric/bilateral
    • Well demarcated, convex borders
    • Macule (flat, <10mm dia) vs patch (>10mm dia)
    • Can be pruritic or tingling
    • Occur mostly around extensor surfaces, periorificial areas
  • Koebner phenomenon: onset of new lesions in areas of cutaneous injury or treatment (in 20-60% of patients)
  • Chorioretinitis: choroid/retinal inflammation

Wood lamb: can help differentiate vitiligo from other pigmentation conditions

Pathophysiology & Etiology

Melanocyte loss/destruction

  • Could be due to cytotoxicity, autoimmunity, oxidant mechanisms

Genetic predisposition

  • Incomplete penetrance, multiple susceptibility loci
  • Affects genes regulating melanin production, autoantibodies

Complications

Figure 2 Leukotrichia variant of vilitgo presenting near hair follicles

Much higher rate of UV-related disease incidence: sunburn, skin cancer

Hearing loss: loss of cochlear melanocytes

Iritis: inflammation of eye iris

Treatment

To protect against UV damage and skin-related complications: SPF, narrow band UVB therapy 2-3x/week (to prevent melanocyte destruction)

Topical treatment: corticosteroids, calcineurin inhibitors

Phototherapy

Surgical treatment options (for segmental or localized vitiligo): grafts, epidermal suspensions

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