1. VITILIGO

2. 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

3. 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.

4. 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

5. 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

6. Facial Vitiligo

7. Vitiligo

8. Vitiligo

9. Trichrome Vitiligo

10. Segmental vitiligo

11. Mucosal vitiligo

12. 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.

13. 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).

14. 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

15. 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 % followed by UVA exposure
Systemic steroids-dexamethazone 10mg twice weekly however, long time use is not recommended
Surgery and total depigmentation

16. Conclusion Discussed light related and Pigmentation disorders
Different types
Treatment modalities

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