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Vitiligo

Skin Hypopigmentation can be Associated with Autoimmunity

Feb 2, 2009 Stephen Allen Christensen

Vitiligo may be a familial condition, it may be associated with underlying autoimmune disease, or it may occur as an isolated phenomenon with no known cause.

Vitiligo is a condition that is characterized by depigmentation of the skin due to a regional loss of melanocytes (the cells that produce melanin). All skin types are affected.

Vitiligo affects 1-2% of the population, with males and females being equally represented. Peak onset is in the seond and third decades; 50 percent of cases occur before 20 years of age. (Fathman EM, Habif TP. Skin Disease: Diagnosis and Treatment, 1st edition. St. Louis, Mo.: Mosby; 2001:308-11)

Vitiligo’s onset is frequently related to a recent emotional stress, illness, or injury to the skin (e.g., sunburn). The condition can be emotionally devastating, depending on individual and ethnic sensitivities regarding uniformity of skin coloring.

The exact cause of vitiligo is unknown, but it is apparently secondary to autoimmune destruction of melanocytes. Approximately 30% of people afflicted with vitiligo possess other autoimmune antibodies or exhibit overt autoimmune conditions. (The Merck Manual, 18th Edition. 2006:1002-03,1208-09)

Signs and Symptoms of Vitiligo

Painless, usually sharply demarcated areas of whitish skin (most commonly involving the face, neck, armpits, groin and genitalia, armpits, backs of the hands, forearms, and body folds)
Premature whitening of patches of hair on the scalp, eyebrows, eyelashes or beard
Loss of color of mucous membranes (e.g., inside of mouth)

Classification of Vitiligo

Vitiligo is classified according to the extent of involvement:

Focal: one or two spots
Segmental: a single extremity or ribbon of skin on one side of the body (i.e., a dermatome)
Acral/acrofacial: involvement of face and distal extremities (so-called “lip-tip” pattern)
Generalized: more than 10% of the body surface is depigmented

Conditions Associated with Vitiligo

Grave’s disease
Hashimoto’s thyroiditis
Addison’s disease (adrenal insufficiency)
Type 1 (autoimmune) diabetes mellitus
Pernicious anemia
Other autoimmune diseases

Risk Factors for Vitiligo (Inconsistent Associations)

Family history (autosomal dominant with incomplete penetrance and variable expression; may account for up to 25-30% of cases)
Co-existing autoimmune conditions
Skin injury (burn, sunburn, dermabrasion, etc.)
Stressful life event

Diagnosis of Vitiligo

Diagnosis is usually straightforward, because vitiligo has a fairly characteristic appearance. However, biopsy may be needed to rule out other conditions.

Evaluation for underlying autoimmune disease is not necessary unless the affected individual has symptoms or signs that suggest such a disorder.

Treatment of Vitiligo

While vitiligo is not curable, it can be treated successfully in many cases. Treatment is based on extent of skin involvement, the pattern of distribution, and the patient’s perceived need for addressing the condition.

Areas on the head and neck tend to respond most readily to therapy, whereas those on the genitalia and extremities (particularly segmental vitiligo) are more stubborn.

Treatment modalities include:

Sun protection: all affected areas burn easily and should be shielded from sunlilght
Cosmetic coverage: Covermark®, Dermablend®, and other concealers
Topical steroids: high-potency steroid creams and lotions (e.g., betamethasone, fluocinonide,etc.)
Phototherapy: topical or oral psoralen drugs, combined with ultraviolet light (PUVA therapy)
Surgical grafting: mini-graft and punch-and-graft modalities for focal, stable disease
Tattooing: useful for hard-to-repigment areas such as lips, nipples and fingertips
Depigmentation: for patients with extensive involvement who want uniform skin color (and who are prepared for permanent “bleaching”), monobenzone cream for six to eighteen months

Although vitiligo may be associated with underlying autoimmunity, the condition itself is painless. However, disfigurement associated with vitiligo can be devastating for certain individuals.

The copyright of the article Vitiligo in General Medicine is owned by Stephen Allen Christensen. Permission to republish Vitiligo in print or online must be granted by the author in writing.

Vitiligo

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Comments

Mar 6, 2009 11:00 PM

Muhammad Irshad :

How one can get rid by skin condition vitiligo, it is slightly difficult task. Your classification of vitiligo into facal, segmental and acrofacial is really a remarkable work after http://www.vitiligoguide.com/ the also clssified vitiligo same as you but the catagerized into five sub catagories.
I specially read vitiligo related articles to know about what different experts say about the cure and causes of vitiligo.
Treatment options which you discribe really outstanding. Please write some lines about causation of this chronic condition.

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