Teaching File: Vitiligo (segmental type)

Diagnosis: Teaching File: Vitiligo (segmental type)

Depigmentation in segmental pattern.

Clinical Presentation

Depigmentation in segmental pattern.

Clinical History

Submitted by Alaa Saad. Originally posted December 18, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Pityriasis alba • Pityriasis versicolor • Post-inflammatory hypopigmentation • Chemical leukoderma • Tinea versicolor • Morphea • Leprosy • Mycosis fungoides (hypopigmented)

Key Learnings

• Autoimmune destruction of melanocytes — T-cell mediated • Wood lamp accentuates depigmented areas (bright white fluorescence) — essential for diagnosis in fair skin • Segmental vitiligo: dermatomal distribution, earlier onset, less associated with autoimmune disease, more stable • Non-segmental vitiligo: progressive, bilateral, associated with autoimmune thyroid disease, type 1 DM, pernicious anemia • Koebner phenomenon present • Screen for associated autoimmune diseases: TSH, CBC, vitamin B12 • Ruxolitinib cream (JAK inhibitor) FDA-approved for non-segmental vitiligo • Repigmentation often starts perifollicularly (from follicular melanocyte reservoir)

Tags: teaching, file, vitiligo, segmental, type, alaa saad