Vitiligo

Diagnosis: Vitiligo

Clinical History

Well-demarcated, depigmented (chalk-white) macules and patches. Distribution: perioral, periocular, hands, feet, genitalia. Family history of autoimmune disease. Screen for thyroid disease.

Treatment

Topical corticosteroids, calcineurin inhibitors (tacrolimus, pimecrolimus). Ruxolitinib cream 1.5% BID (FDA-approved). NB-UVB phototherapy (most effective for widespread). Surgical: melanocyte transplant for stable, segmental vitiligo. Sun protection of depigmented areas.

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