Diane Jackson-Richards - Dermatology Atlas for Skin of Color

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Part I
Pigmentary Disorders

Springer-Verlag Berlin Heidelberg 2014

Diane Jackson-Richards and Amit G. Pandya (eds.) Dermatology Atlas for Skin of Color 10.1007/978-3-642-54446-0_1

1. Vitiligo

Sharif Currimbhoy 1

(1)

Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, Dallas, TX 75235, USA

(2)

Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA

Sharif Currimbhoy

Email:

Amit G. Pandya (Corresponding author)

Email:

1.1

1.2

1.3

1.4

1.5

1.6

1.1 Introduction

Vitiligo is a chronic depigmenting skin disease that is caused by progressive autoimmune-mediated melanocyte destruction [].

1.2 Clinical Features

Vitiligo is separated into two main variants, each with a different presentation and clinical course. Non-segmental vitiligo (NSV), also called generalized vitiligo, is the most common form, seen in approximately 90 % of cases, and is generally more rapidly progressive in its course than segmental vitiligo [).

Fig. 1.1

Bilateral vitiligo in a Hispanic male

Fig. 1.2

Vitiligo of the forearm in a Hispanic female

Fig. 1.3

Vitiligo of the back in a South Asian boy demonstrating the Koebner phenomenon after a scratch

Fig. 1.4

Trichrome vitiligo on the arm of an African American female

Segmental vitiligo (SV) is less common than NSV and typically begins at a younger age, with roughly 30 % of cases presenting during childhood [].

Fig. 1.5

Segmental vitiligo of the neck in a South Asian female

Fig. 1.6

Segmental vitiligo of the left upper eyelid in an African American male

In both segmental and non-segmental vitiligo, retention of hair pigment is a good prognostic sign (Fig. ).

Fig. 1.7

Extensive vitiligo in a Filipino male with retention of hair pigment

Fig. 1.8

Leukotrichia in a patch of vitiligo in a Hispanic male

Fig. 1.9

Severe bilateral vitiligo in an African American male

1.3 Diagnosis and Differential Diagnosis

A diagnosis of vitiligo can usually be made simply by clinical examination, although the use of Woods lamp may be used in patients with Fitzpatrick skin types IIII to highlight areas of depigmentation. The differential diagnosis for vitiligo includes tinea versicolor, pityriasis alba, post-inflammatory hypopigmentation, idiopathic guttate hypomelanosis, nevus depigmentosus, halo nevus, and piebaldism [].

1.4 Histopathological Features

Histologic examination of the skin from a lesion of vitiligo reveals lack of melanocytes, often with a sparse infiltrate of lymphocytes [].

1.5 Natural History and Prognosis

The disease course of NSV is typically progressive, although the time frame and areas of spread are difficult to predict. As mentioned previously, areas with frequent trauma or pressure, such as the dorsal hands, waist, elbows, knees, and dorsal feet, have a higher chance of depigmentation and are common areas of involvement.

Segmental vitiligo tends to be more stable in its disease course, with rare spread to other distal body regions outside of the affected dermatome or Blaschkos lines [].

Thyroid dysfunction, hypothyroidism or hyperthyroidism, may be found in up to 18 % of patients, and screening is recommended for new patients [].

1.6 Treatment

Treatment options for vitiligo include both topical corticosteroids and immunomodulators, phototherapy with psoralen and ultraviolet A radiation (PUVA), narrowband ultraviolet B (NBUVB), and surgical modalities. The expectations for repigmentation should be discussed with patients, as all therapies require a long-term commitment and strict adherence to the treatment protocol. Potent topical corticosteroids are an effective therapy and have been shown to achieve greater than 75 % repigmentation in 56 % of patients with long-term use [].

Fig. 1.10

Vitiligo of the right knee in a Hispanic female with repigmentation from phototherapy

Fig. 1.11

Vitiligo of the right cheek in an African American female before depigmentation therapy

Fig. 1.12

Vitiligo of the right cheek in an African American female after depigmentation therapy

References

Taeb A, Picardo M. Clinical practice. Vitiligo. N Engl J Med. 2009;360(2):1609. PubMed CrossRef

Alikhan A, Felsten LM, Daly M, Petronic-rosic V. Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. J Am Acad Dermatol. 2011;65(3):47391. PubMed CrossRef

Speeckaert R, Van Geel N. Distribution patterns in generalized vitiligo. J Eur Acad Dermatol Venereol. 2013. doi: 10.1111/jdv.12171 . [Epub ahead of print].

Ongenae K, Van Geel N, De Schepper S, Naeyaert JM. Effect of vitiligo on self-reported health-related quality of life. Br J Dermatol. 2005;152(6):116572. PubMed CrossRef

Alghamdi KM, Kumar A, Taeb A, Ezzedine K. Assessment methods for the evaluation of vitiligo. J Eur Acad Dermatol Venereol. 2012;26(12):146371. PubMed

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