Vitiligo Disease

DESCRIPTION

An acquired, slowly progressive depigmenting condition in small or large areas of the skin due to the disappearance of previously active melanocytes

Type A is non-dermatomal and widespread. It represents 75% of cases
Type B is dermatomal or segmental. It represents the remaining 25% of cases
System(s) affected: Skin/Exocrine
Genetics: Autosomal dominant with variable expression and incomplete penetrance. Positive family history in 30% of cases.
Incidence/Prevalence in USA: 1000-2000/100,000
Predominant age: All ages: 50% begin between ages 10 and 30
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Loss of pigment
Locally increased sunburning
Predilection for acral areas and around orifices such as eyes, mouth, anus
Pruritus (10%)
Premature graying (35%)
Koebner's phenomenon (aggravation by trauma)

CAUSES

Etiology is unclear, but is thought to be an autoimmune reaction to preexisting melanocytes

RISK FACTORS

Positive family history
Autoimmune disorders including hemolytic anemia and adrenal insufficiency

LABORATORY

Routine blood and urine studies are usually normal in the absence of associated diseases in adults. In children screen for autoimmune diseases with TSH, CBC, and fasting glucose.

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Complete absence of melanocytes in skin biopsy. At the margins one may see a few lymphocytes and large melanocytes with abnormal melanosomes.

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Examination under Wood's light accentuates the hypopigmented areas, especially in light-skinned individuals
Skin scraping and a potassium hydroxide (KOH) preparation can be examined microscopically to rule out tinea versicolor

APPROPRIATE HEALTH CARE

Outpatient except in rare cases of surgical skin-grafting or transplantation

GENERAL MEASURES

Sun exposure can accentuate the difference between normal and abnormal skin, so for cosmetic reasons patients may wish to avoid this
Skin dyes and cosmetics may be used as cover-ups

SURGICAL MEASURES

N/A

ACTIVITY

Full activity

DIET

No special diet

PATIENT EDUCATION

Reassure patient that in absence of associated autoimmune illness the problem is purely cosmetic. Successful cosmetic cover-up is usually quite simple. Some areas offer vitiligo support groups.
Information available through National Vitiligo Foundation, P.O. Box 6337, Tyler TX 75711; (903)531-0074

PREVENTION/AVOIDANCE

While undergoing all therapies, avoid excessive sun exposure

POSSIBLE COMPLICATIONS

Phototoxic reactions ranging from mild to severe with PUVA
Skin atrophy and telangiectasias with topical steroids
Contact dermatitis can occur with use of depigmenting agents and cosmetic covers

EXPECTED COURSE AND PROGNOSIS

Only 5% spontaneously repigment
Best results are with PUVA therapy where 70% have repigmentation of head and neck area, less in other body areas. Lower percentages respond to topical therapy
There is no response in at least 20% of cases, especially long-standing cases
Once repigmentation occurs it usually persists

ASSOCIATED CONDITIONS

Addison's disease
Alopecia areata
Chronic mucocutaneous candidiasis
Diabetes mellitus
Hypoparathyroidism
Melanoma
Pernicious anemia
Polyglandular autoimmune syndrome
Thyroid disorders (hyper- and hypothyroidism) - 30% of patients with vitiligo
Uveitis
Halo nevi

AGE-RELATED FACTORS

Pediatric: Childhood vitiligo is a distinct subset of vitiligo. Higher incidence of Type B (segmental) vitiligo. Also higher incidence of autoimmune and endocrine disease. Response is poor to topical PUVA therapy, but can be tried. Topical steroids may be prescribed, e.g., ´desonide´ 0.05% cream qDay for 4 months
Geriatric: NA
Others: NA

PREGNANCY

Treatment with topical or oral psoralens is contraindicated

OTHER NOTES

If PUVA therapy considered, dermatologic consultation should be considered

ABBREVIATIONS

CBC = complete blood count

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.