1. Vitiligo

2. What is Vitiligo? Chronic skin disease Other name = Leukoderma
White spots occur when the skin no longer forms melanin (pigment that determines the color of your skin, hair, and eyes)
The white patches of irregular shapes begin to appear on your skin

3. Symptoms & Signs White patches of skin
Whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard
Loss of color in the tissues that line the inside of your mouth
Loss or change in color of the inner layer of your eye

4. White Vitiligo Spots Chalk white color Convex margins
5mm to 5cm or more in diameter
Round, oval, or elongated in shape

5. 3 patterns:
Focal pattern—the depigmentation is limited to one or only a few areas
Segmental pattern—depigmented patches develop on only one side of the body
Generalized pattern—(most common) depigmentation occurs symmetrically on both sides of the body
Focal and segmental patterns do not spread. The generalized pattern is hard to predict and can randomly stop

11. Facts:
Can appear at any age, usually first appears between the ages of 20 and 30
White patches may begin on your face above your eyes or on your neck, armpits, elbows, genitals, hands or knees
1-200 of the world population develops
Affects both genders and all races equally

12. Causes:
When no melanin is produced, the involved patch of skin becomes white
When a white patch grows or spreads the cause may be Vitiligo
Exact cause is unknown
May be due to an immune disorder, heredity, or environmental causes like sunburn or emotional distress that trigger the condition

13. Treatment Vitiligo is difficult to treat
Early treatment options include:
Exposure to intense ultraviolet light, such as narrow-band UVB therapy
Photosensitizers taken by mouth such as trimethylpsoralen (Trisoralen) plus UVA exposure
Topicals:
Corticosteroid creams (weak effect)
Immunosuppressants such as pimecrolimus (Elidel) and tacrolimus (Protopic)
Repigmenting agents such as methoxsalen (Oxsoralen)
Excimer lasres
Systemic steroids

14. If the affected body surface area is more than 40%, then it is better to bleach (depigment) the remaining normal skin in order to unify the body’s color by using 20% monobenzone cream.

15. Psoralen photochemotherapy (Psorglen & Ultraviolet A Therapy & PUVA therapy)
Most effective treatment available in the United States.
PUVA therapy is to repigment the white patches
time-consuming, and care must be taken to avoid side effects
Psoralen is a drug that contains chemicals that react with ultraviolet light to cause darkening of the skin.
Psoralen is taken orally or is applied to the skin
Then skin is carefully timed exposure to sunlight or to ultraviolet A (UVA) light that comes from a special lamp.

16. Topical psoralen photochemotherapy Oral psoralen photochemotherapy
TREATMENTS
Topical psoralen photochemotherapy
Used for children 2 years old and older who have small number white spots in a few areas
Treatments are done under an artificial UVA light once or twice a week.
Psorglen is applied to your depigmented patches about 30 minutes before exposing you to enough UVA light to turn the affected area pink.
The doctor usually increases the dose of UVA light slowly over many weeks.
Eventually, the pink areas fade and a more normal skin color appears.
SIDE EFFECTS:
(1) severe sunburn and blistering
(2) too much repigmentation or darkening (hyperpigmentation) of the treated patches or the normal skin surrounding the vitiligo.
Oral psoralen photochemotherapy
For people with extensive vitiligo (affecting more than 20 percent of the body) or for people who do not respond to topical PUVA therapy
Not recommended for children under 10 years of age because it increases the risk of damage to the eyes caused by conditions such as cataracts.
You take a prescribed dose of psoralen by mouth about 2 hours before exposure to artificial UVA light or sunlight.
Treatments are usually given 2 or 3 times a week, but never 2 days in a row. For patients who cannot go to a facility to receive PUVA therapy, the doctor may prescribe psoralen that can be used with natural sunlight exposure.
SIDE EFFECTS include:
Sunburn, nausea and vomiting, itching, abnormal hair growth, and hyperpigmentation.
May also increase the risk of skin cancer,

17. Autologous skin grafts Skin grafts using blisters
Surgical Therapies
Autologous skin grafts
Used for people with small patches of vitiligo
The doctor removes sections of the normal, pigmented skin and places them on the depigmented areas
Infections may occur at the donor or recipient sites
The recipient and donor sites may develop scarring, a cobblestone appearance, or a spotty pigmentation, or may fail to cure the white spot area
Takes time and is very costly
Skin grafts using blisters
Doctor creates blisters on your pigmented skin by using heat, suction, or freezing cold
The tops of the blisters are then cut out and transplanted to a depigmented skin area
SIDE EFFECTS: scarring and lack of repigmentation
Less risk of scarring with this procedure than with other types of grafting.

18. Sun awareness and camouflage
Sunscreen
Helps protect the skin from sunburn and long-term damage
Minimizes tanning, which makes the contrast between normal and depigmented skin less noticeable
Cosmetics
Dermablend