VITILIGO

Introduction/Epidemiology An acquired pigmentary anomaly of the skin which manifest by depigmented white patches surrounded by a normal or hyperpigmented border Begins in childhood & young adulthood Peak age of onset b/w 10 & 30 years, about half begin before 20years Prevalence ranges from 0.5-1% Females are disproportionately among those seeking care Transmission is polygenic

Introduction Have developed in recipients of bone marrow transplant or lymphocyte infusions from patients with vitiligo Has a genetic background, more than 30% affected persons would have had vitiligo in a parent, sibbling or child. Risk factors for developing vitiligo:-autuimmune diseases eg Hashimotor thyroiditis, type 1 DM, pernicious anaemia, Grave’s disease, addison’s disease and alopecia areata so persons with family history of vitiligo should have antithyroid globulin.

Types Six types are described: localized or focal; segmental; generalized(common symmetric); universal; acrofacial; and mucosal, Generalized pattern is most common & symmetrical Commonly affected sites are face, upper chest, dorsum of hands, axilla &groin. Also has tendency to affect the skin around orifices- eyes, ears, nose, mouth, nipples, anus, vulva, penis, umbilicus

Types Focal vitiligo represents 5% of adult vitiligo & 20% of childhood vitiligo Lesions of vitiligo are hypersensitive to UV light and burn readily when exposed to sun however tolerate it when exposed repeatedly- photoadaptation Occular abnormalities are common in patients with vitiligo: iritis & retinal pigmentary abnormalities Patients have no visual complaints

Facial Vitiligo

Vitiligo

Vitiligo

Trichrome Vitiligo

Segmental vitiligo

Mucosal vitiligo

Severity assessment Usually it is not formally assessed but pictures are taken to monitor progress 2 scoring systems are devised in clinical practice Vitiligo area scoring index (VASI) & Vitiligo European Task force system (VETF) VASI:-It measures the extent and degree of depigmentation in 6 sites: hands, upper extremities, trunk, lower extremities and feet, head/neck.

Severity assessment VETF :-The VETF assesses extent, staging and spreading/progression in 5 sites: head/neck, trunk, arms, legs and hands/feet. It grades from 0 (normal pigmentation) to 4 (complete hair whitening). Spreading is assessed using the following scores: 0 (stable disease), -1 (regressive disease) and +1 (progressive disease).

Treatment Psychological effect of vitiligo cannot be underestimated Treatment can be frustrating, repigmentation occurs in 15-25% of patients & response is slow and low Response to treatment is different in different persons and depends on skin type. Facial vitiligo has excellent prognosis, only 10-20% of patients with vitiligo of dorsum of hands & feet respond to treatment while truncal vitiligo has intermediate response

Treatment Non-treatment for those with low Fitzpatrick’s phototypes (I & II) Medical camouflage Topical superpotent steroids usually 4-6 months Topical pimecrolimus cream and tacrolimus ointment 0.1% particularly in facial vitiligo NBUVB twice weakly Topical 8-methoxypsoralen 0.01-0.1% followed by UVA exposure Systemic steroids-dexamethazone 10mg twice weekly however, long time use is not recommended Surgery and total depigmentation

Conclusion Discussed light related and Pigmentation disorders Different types Treatment modalities

WHAT IS THIS?

What is this?

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