vitiligo
Jump to navigation
Jump to search
Etiology
- presumed autoimmune in origin, anti-melanocyte
- often seen in association with autoimmune disorders
- acquired condition, congenital cases are rare
Epidemiology
- incidence is approximately 1%
- affects both sexes equally
- more noticeable in dark-skinned individuals
- peak incidence between 10-30 years
Pathology
- loss & absence of melanocytes
- minimal inflammation
Genetics
- 30% of patients have an affected family member
- inheritance pattern is unclear
- mutations in gene for F-box only protein-11
- susceptibility to vitiligo is associated with variations in PTPN22
Clinical manifestations
- hypopigmented macules
- 1 mm to several cm in diameter
- generally white, but may be off-white or tan in color
- circular or oval in shape, may have scalloped edges
- accentuated by viewing with Wood's lamp, especially in light-skinned patients
- focal, segmental or generalized in distribution
- perifollicular skin may be spared[10]
- generalized vitiligo tends to occur in a symmetric pattern
- areas of frequent trauma, i.e. fingertips, bony prominences affected early
- common sites include
- other skin manifestations
- iritis is seen in 10% of patients with vitiligo
- signs associated with concomitant autoimmune disorder
Laboratory
- diagnosis is made by history & physical examination, laboratory testing is rarely needed
- skin biopsy reveals normal skin except for an absence of melanocytes
- screening tests for associated autoimmune disorders
- PTPN22 gene mutation
Diagnostic procedures
- lesions more apparent under Wood's lamp (chalk white)
Complications
- often seen in association with autoimmune disorders
- see etiology (above)
- patients with vitiligo more likely to develop dementia (RR=5.3)[9]
- Alzheimer's dementia (RR=12.2)
- vascular dementia (RR=4.0)[9]
- increased risk of sensorineural hearing loss in children[11]
Differential diagnosis
- tinea versicolor
- ash-leaf spot associated with tuberous sclerosis
- pityriasis alba
- post inflammatory hypopigmentation
- leprosy
- systemic lupus erythematosus
- chemical leukoderma
- nevus anemicus
Management
- primarily of cosmetic & social concern
- reassurance & no further treatment is OpenEvidence recommendation
- tends to be stable initially, then progresses over several years
- untreated vitiligo usually remains for life, but some individuals spontaneously repigment depigmented areas
- sunscreens (SPF > 30) will diminish pigmentation of adjacent areas which make the vitiligo more noticeable
- cosmetics may provide good results
- pharmacologic agents
- topical steroids for isolated lesions (MKSAP20 preferred management)[3]
- hydrocortisone 1% or 2.5% on face & skin folds
- more potent steroids elsewhere (Clobetasol 0.05%)[3][12]
- use interrupted schedule if steroids are used for more than 6-8 weeks to reduce risk of steroid atrophy
- topical PUVA photochemotherapy or oral psoralen for more extensive disease
- topical ruxolitinib (Opzelura) FDA-approved
- topical steroids for isolated lesions (MKSAP20 preferred management)[3]
- depigmentation of normal skin with monobenzone (Benzoquin)
- permanent, uniform bleaching of remaining normal skin
- may be useful for patients with extensive disease
More general terms
Additional terms
- F-box only protein 11; vitiligo-associated protein 1; VIT-1 (FBXO11, FBX11, VIT1, UG063H01)
- Vogt-Koyanagi-Harada syndrome (VKH)
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 952-53
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 296
- ↑ 3.0 3.1 3.2 3.3 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17. American College of Physicians, Philadelphia 2009, 2012, 2015
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Huggins RH, Schwartz RA, Janniger C. Vitiligo Acta Dermatovenerol Alp Pannonica Adriat. 2005 Dec;14(4):137-42, 144-5 PMID: https://pubmed.ncbi.nlm.nih.gov/16435042
- ↑ 5.0 5.1 Vitiligo (image) American Academy of Dermatology https://www.aad.org/public/diseases/color-problems/vitiligo
- ↑ 6.0 6.1 Groysman V, Elston DM (images) Medscape: Vitiligo http://emedicine.medscape.com/article/1068962-overview
- ↑ 7.0 7.1 DermNet NZ. Vitiligo (images) http://dermnetnz.org/colour/vitiligo.html
- ↑ Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. J Am Acad Dermatol. 2011 Sep;65(3):473-491. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/21839315
Felsten LM, Alikhan A, Petronic-Rosic V. Vitiligo: a comprehensive overview Part II: treatment options and approach to treatment. J Am Acad Dermatol. 2011 Sep;65(3):493-514. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/21839316 - ↑ 9.0 9.1 9.2 Chang TH, Tai TH, Dai YX et al Association between vitiligo and subsequent risk of dementia: A population-based cohort study. J Dermatol. 2020. Nov 12 PMID: https://pubmed.ncbi.nlm.nih.gov/33180352 https://onlinelibrary.wiley.com/doi/abs/10.1111/1346-8138.15582
- ↑ 10.0 10.1 10.2 10.3 Elston CA, Elston MD Identifying Lesions on Skin of Color. Medscape. 2021. May 10 https://reference.medscape.com/slideshow/identifying-lesions-6007985
Elston CA, Elston DM Identifying Lesions on Skin of Color. Medscape. October 25, 2022 https://reference.medscape.com/slideshow/identifying-lesions-6007985 - ↑ 11.0 11.1 Tsai SY et al. Auditory and ocular manifestations in pediatric vitiligo. JAMA Dermatol 2025 Aug; 161:879 PMID: https://pubmed.ncbi.nlm.nih.gov/40498511 PMCID: PMC12159847 (available on 2026-06-11) https://jamanetwork.com/journals/jamadermatology/fullarticle/2835071
- ↑ 12.0 12.1 Bergqvist C, Ezzedine K. Vitiligo: A review. Dermatology. 2020;236:571-592. PMID: https://pubmed.ncbi.nlm.nih.gov/32155629
- ↑ National Institute of Arthritis and Muscluloskeletal and Skin Diseases (NIAMS) Vitiligo https://www.niams.nih.gov/health-topics/vitiligo