Vitiligo

Background

  • Condition which causes patchy depigmentation of the skin characterized by absence of melanocytes
  • Flat achromic patches more commonly found in extremities or concave areas of body surface
  • Related with autoimmune diseases such as thyroid gland pathologies as well as melanoma
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Differential Diagnosis

  • Pityriasis versicolor
    • light desquamation, blurred borders
  • Pityriasis alba
    • Wood's lamp examination with yellow/green fluorescence
    • KOH positive
  • Chemical leukoderma
  • Tuberculoid Leprosy (Hansen's disease)
  • Hipopigmented nevus
    • stable macule, unilateral
  • Hipomelanosis of Ito (Incontinentia pigmenti achromians)
    • follows lines of Blaschko
  • Nevus anemicus
    • no contrast on Wood's lamp examination
    • no erythematous response to trauma, cold or heat
  • Tuberous sclerosis
    • stable polygonal confetti macules
  • Piebaldism
    • alternating hyperpigmented macules on hipopigmented patches
    • triangular shaped depigmented patch on forehead
  • Tinea versicolor

Management

  • Less than 20% skin surface affected
    • Corticosteroid cream, calcineurin inhibitors
    • UVB or PUVA phototherapy
    • Melanocyte grafting (risk of Koebner phenomenon)
    • Cosmetic camouflage solutions
  • Over 20% skin depigmentation
    • Narrow band UVB phototherapy
    • Total skin depigmentation (with sun protection)

See Also

References