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Vitiligo.
Comprehensive overview of vitiligo including causes, symptoms, diagnosis, and treatments with clinical examples and notable cases.
Key Takeaways
- Vitiligo results from melanocyte loss causing skin depigmentation.
- Genetic and autoimmune factors play significant roles in its development.
- Diagnosis is clinical; thyroid tests may be ordered due to common associations.
- Topical corticosteroids and UV therapy are primary treatments.
- Complete depigmentation therapy can be used for extensive vitiligo to achieve uniform skin tone.
Summary
- Vitiligo is a skin condition characterized by loss of melanocytes leading to depigmentation.
- Etiology includes genetic factors (autosomal dominant), autoimmune causes, and occupational exposure to chemicals.
- Commonly affects face, hands, and fingers, with more pronounced appearance in darker skin tones.
- Diagnosis is primarily clinical, sometimes supported by thyroid function tests due to associated thyroid disorders.
- First-line treatment involves topical corticosteroids to blend depigmented patches with normal skin.
- Ultraviolet (UV) therapy is also used as a treatment option.
- Complete depigmentation of normal skin using monobenzyl ether or hydroquinone can achieve uniform skin tone.
- Michael Jackson is a famous example of vitiligo, who underwent full-body depigmentation treatment.
- Clinical vignettes illustrate occupational vitiligo and pediatric cases with family history of autoimmune diseases.
- Management excludes antifungals, chemotherapy, and sun avoidance; focuses on corticosteroids and phototherapy.
Full Transcript — Download SRT & Markdown
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And vitiligo essentially is a skin condition in which the person has a loss of skin melanocytes.
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Melanocytes, of course, are the skin cells that are responsible for pigment, and this results in depigmentation, of course, and can be quite devastating in the individual.
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And the etiology is actually not entirely understood.
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But they think that there is a strong genetic component, and in particular autosomal dominant.
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There's also studies that have shown that there is an autoimmune etiology.
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And there is also a strong association of vitiligo with thyroid disorders.
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And sometimes vitiligo can happen on the job when you are exposed to certain chemicals.
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And that type of vitiligo, of course, is called occupational vitiligo.
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In terms of symptoms or appearance.
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Basically, it starts off as hypopigmented or depigmented areas.
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And these can occur pretty much anywhere on the body.
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But more commonly, they tend to occur on the face and on the hands and fingers.
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But they can eventually appear anywhere.
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And it's more pronounced in people, of course, that have darker skin.
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So I wanted to show you an example.
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So here's a picture of a hand, obviously, with patches of depigmentation.
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And initially, it starts off like this.
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But then these patches tend to get bigger and bigger and spread all over the body.
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And that can eventually lead to a situation where there's more depigmentation than normal pigment.
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In terms of diagnosis, really, there's no tests.
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It's really just a clinical diagnosis.
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But sometimes physicians will also order some thyroid tests.
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Because there's an association with thyroid disorder.
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And in terms of treatment.
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The first line treatment are topical corticosteroids.
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And the reason is because these medications can cause hypopigmentation in the normal surrounding skin.
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And that can help blend in the vitiligo.
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In addition to topical corticosteroids, ultraviolet light or ultraviolet therapy is also used.
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And the most significant type of treatment involves doing something that will completely depigment all the normal skin.
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So that the vitiligo will match the entire body.
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So the depigmentation of normal skin to achieve a homogeneous skin tone throughout the body is possible.
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And it can be accomplished with two types of treatments.
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The one is with monobenzyl ether.
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And the other is with a medication known as hydroquinone.
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And the most famous person probably to have vitiligo was a singer named Michael Jackson.
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And he eventually became completely depigmented.
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In 1984, he started to notice vitiligo on his hand.
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And he used to cover it up with that famous glove.
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One-handed glove.
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And then later, he started noticing it on different parts of his body.
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So he approached dermatologists and they basically decided to bleach his entire body so that the skin would have a homogeneous tone to match the depigmentation that the vitiligo had caused.
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So let's take a look at a couple of vignettes.
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A 57-year-old man comes to your office complaining of the famous musician disease on his hands.
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He denies any family or personal history of diabetes, anemia, thyroid disease, or sudden onset of patches of hair loss.
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He works as a janitor at a local apartment building.
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His job involves mostly wiping equipment at the end of the day with antiseptics.
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Physical examination shows well-demarcated, depigmented patches on his fingers and the dorsum of the hands.
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Wood's light examination enhances these areas as fluorescent white patches.
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There are no texture changes or scaling associated with these areas.
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There is no involvement around the mouth, nipple, upper chest, axillae, groin, and glans penis.
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The most likely diagnosis is.
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Well, this is a case of vitiligo.
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But because he was exposed to these chemicals on the job.
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It is a occupational vitiligo.
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And finally.
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A 10-year-old African-American boy is brought into the office by his mother because of concerns over white spots on his skin that are increasing in size and number.
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His mother reports the first spot began 2-3 years ago on his right index finger, which was stable until recently when it increased in size.
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Of more concern to the mother was the increase in the number of similar lesions of various size around his mouth, anus, and penile tip.
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Further questioning reveals a family history of diabetes and thyroid disease.
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Full skin examination shows depigmented, flat patches that are well demarcated with no scales or surrounding erythema located at the perioral, perianal, tip of penis, and bilateral knees as well as right index and middle fingers.
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Management of this patient should include.
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Well, chemotherapy, it's not cancer.
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Ketoconazole, it's not a fungal infection.
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Sunscreen, sun avoidance, it's not a sunburn.
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Topical antifungal, again, not a fungal infection.
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So by process of elimination, we got E.
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But E is indeed the first line treatment.
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Topical corticosteroids can cause hypopigmentation in the normal surrounding skin to blend in the depigmentation that has been caused by vitiligo.
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And you phototherapy or UV therapy is also commonly used to treat vitiligo.
Topics:vitiligoskin depigmentationmelanocytesautoimmune diseasetopical corticosteroidsUV therapyoccupational vitiligothyroid disordersmonobenzyl etherhydroquinone
