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Updated: Dec 16 2021


  • Snapshot
    • A 45-year-old woman presents to her dermatologist for further management of her vitiligo. In the past few months she has been very stressed with trouble at work, home, and recent deaths in the family. Her vitiligo has spread from her hands to her arms, face, chest, back, and legs. Given the widespread nature of her disease, she is started on phototherapy with pulses of oral steroids.
  • Introduction
    • Clinical definition
      • autoimmune disease characterized by absent pigmentation due to loss of functioning melanocytes
    • Associated conditions
      • vitamin D deficiency
      • thyroid disease
      • alopecia areata
  • Epidemiology
    • Demographics
      • onset between 10-30 years of age
    • Risk factors
      • family history of vitiligo
    • Pathogenesis
      • exact mechanism is unknown
      • theories include
        • autoimmune attack on melanocytes
        • stress leading to neurogenic factors that affect melanocyte survival
        • reactive oxygen species attack on melanocytes
  • Presentation
    • Symptoms
      • asymptomatic
    • Physical exam
      • depigmented patches (not just lack of a tan or hypopigmentation)
        • sharply demarcated white lesions
      • Wood lamp can highlight these areas
        • fluorescence
  • Studies
    • Biopsy
      • rarely needed
      • only done when clinical diagnosis is unclear
    • Histology
      • absence of melanocytes on tissue slide
      • loss of epidermal pigmentation
  • Differential
    • Tinea versicolor
    • Pityriasis alba
  • Treatment
    • Conservative
      • cosmetic camouflage
        • indication
          • for patients who wish to camouflage the vitiligo patches
        • modalities
          • temporary makeup to color skin
          • tattoo
          • bleaching skin to produce uniform color
      • sunscreen
        • indication
          • to protect against sunlight
    • Medical
      • topical corticosteroids
        • indication
          • for localized disease
      • topical calcineurin inhibitors
        • indication
          • for localized disease
      • phototherapy
        • indications
          • for widespread disease
          • used often with topical vitamin D analogs or oral corticosteroids
        • modalities
          • narrowband ultraviolet B
          • psoralen with ultraviolet A
      • oral corticosteroids
        • indication
          • used either alone or with phototherapy
  • Complications
    • Poor quality of life and psychologic burden
  • Prognosis
    • Chronic disease that waxes and wanes
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