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What is Vitiligo?
Vitiligo is one of the many disorders of skin pigmentation with its incidence being less than 1% throughout the world. It is prevalent in all races but it is most apparent in darkly pigmented individuals. It is an acquired disorder that presents as well demarcated, irregular macules or skin patches that are devoid of pigmentation. The skin lesions may vary in size from a few to many centimeters. They often involve hands, wrists, axillae, perioral, periorbital and anogenital skin. The exact cause of vitiligo being unknown, its etiology may be traced to autoimmunity, neurohormonal factors or self destruction of melanocytes by toxic intermediates of melanin synthesis.
Signs and Symptoms of Vitiligo:
Most frequent and obvious presentation of vitiligo includes acquired white or hypopigmented macules or patches. The lesions are usually flat, well demarcated, round, oval, or linear in shape. Since the disease is progressive in nature, the lesions may enlarge centrifugally over time at an unpredictable rate. Lesions vary in size from a few millimeters to centimeters. Most frequent sites for the lesions being hands, wrists, forearms, feet, and face. There is a predilection for perioral and periorbital skin.
Classification of Vitiligo:
Dermatologists frequently classify vitiligo as localized or generalized. The generalized type is more common.
Some other less common signs of vitiligo may include:
Premature whitening (leukotrichia) or graying of the hair on scalp, eyelashes, eyebrows or beard. Vitiligo of the scalp usually
appears as a localized patch of white or gray hair, but total depigmentation of all scalp hair may occur. Scalp involvement is the
most frequent, followed by involvement of the eyebrows, pubic hair, and axillary hair, respectively.
Loss of pigment of the mucous membranes
Loss or change in color of the retina (the inner most layer of eye)
Differential Diagnosis:
Addison Disease
Piebaldism
Alezzandrini Syndrome
Pityriasis Alba
Chemical leukoderma
Postinflammatory depigmentation
Halo Nevus
Prior treatment with corticosteroids
Idiopathic Guttate Hypomelanosis
Scleroderma
Leprosy
Tinea Versicolor
Malignant Melanoma
Treponematosis
Mycosis fungoides mimicking vitiligo
Tuberous Sclerosis
Nevus Anemicus
Vogt-Koyanagi-Harada Syndrome
Onchocerciasis (River Blindness)
Waardenburg Syndrome
How to diagnose Vitiligo?
Although the diagnosis of vitiligo generally is made on the basis of clinical findings, biopsy is occasionally helpful for differentiating vitiligo from other hypopigmentary disorders.
Microscopic examination of involved skin shows a complete absence of melanocytes in association with a total loss of epidermal pigmentation. Superficial perivascular and perifollicular lymphocytic infiltrates may be observed at the margin of vitiliginous lesions, consistent with a cell-mediated process destroying melanocytes. Degenerative changes have been documented in keratinocytes and melanocytes in both the border lesions and adjacent skin. Other documented changes include increased numbers of Langerhans cells, epidermal vacuolization, and thickening of the basement membrane. Loss of pigment and melanocytes in the epidermis is highlighted by Fontana-Masson staining and immunohistochemistry testing.
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