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

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

Treatment

• 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

• Rash
• Tinea versicolor

Source

Fitzpatrick. Atlas of Dermatology. 5ed en.wikipedia.org/wiki/Vitiligo