Vitiligo

Diagnosis: Vitiligo

Depigmented patches on dorsal hand (knuckle pads), areas subjected to repeated trauma.

Clinical Presentation

Depigmented patches on dorsal hand (knuckle pads), areas subjected to repeated trauma.

Clinical History

Submitted by Alaa Saad. Originally posted September 15, 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: vitiligo, alaa saad