Presented by : Mais Al- Joulany Alaa Sherif
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Presented by : Mais Al-Joulany Alaa Sherif VITILIGO SUPERVISOR : DR. SAMI … DERMATOLOGY
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DERMATOLOGY. VITILIGO. SUPERVISOR : DR. SAMI …. Presented by : Mais Al- Joulany Alaa Sherif. Case study. - PowerPoint PPT Presentation
Transcript of Presented by : Mais Al- Joulany Alaa Sherif
Presented by : Mais Al-Joulany Alaa Sherif
VITILIGOSUPERVISOR :
DR. SAMI …
DERMATOLOGY
A 26 year old young man presented with depigmented patches on face (below the eyes) and neck 2 yrs. Along with this, he also complained of eructation which was worse after food, incontinence of urine with sudden urging and sticky watery
discharge from ears since 5 yrs which was worse after head bath .
Lesions first appeared on forehead which disappeared of its own and then gradually appeared below eyes, on lips and on neck. The lesions were of progressing type. The patient did not receive any treatment for the above complaints prior to this visit.
There was no family history of vitiligo. Childhood history was uneventful. He discontinued studies due to his lack of interest. He started working in a cloth shop from 15 yrs of age.
Case study
Patient had desire for sweets and fried food and cold climate; was intolerant to warm weather with profuse perspiration from soles.
There was sudden urging for urination .
He was mild, gentle and had a clear conception. He was dark and moderately built, weigh 60 kg. and height 160 cm; blood
pressure maintained at 120/80 mm of Hg, Pulse rate of 75/minute and Respiratory rate 20/minute. On examination
tenderness of left hypochondria on palpation, no other systemic abnormality was detected.
Case study
• hot patient • Desires sweets
• Profuse perspiration from soles• Sudden urging to urinate
• White discoloration of skin• Eructations <after eating.
• Sticky watery discharge from ear <head bath.
Case summery
- Pityriasis alba
- Pityriasis versicolor alba
- Chemical leukoderma
- Leprosy
- Nevus depigmentosus
- Hypomelanosis of Ito
- Nevus anemicus
- Leukoderma associated with melanoma
- Postinflammatory leukoderma
- Mycosis fungoides
Differential Diagnosis
Hypomelanosis is a decrease of melanin in the epidermis. This reflects mainly two types of changes:
▪No decrease of melanocytes but a decrease ofthe production of melanin only that is calledmelanopenic hypomelanosis (an example is albinism).
▪A decrease in the number or absence ofmelanocytes in the epidermis producing noor decreased levels of melanin. This is calledmelanocytopenic hypomelanosis (an example is vitiligo)
Introduction
Incidence: Common, worldwide. Affects up to 1% of the population.
Sex : Equal in both sexes
Age of Onset: begin at any age, but in 50% of cases it begins between the ages of 10 and 30 years .
Race: All races, most common in India, Mexico, Japan, Egypt and other tropical countries.
of vitiligo cases Inheritance: in about 30 % there is a positive family history.
Introduction
Vitiligo is a chronic ,acquired ,idiopathic depigmentary condition
The cause of vitiligo is not yet fully understood. Three principal theories have been presented about the mechanism of destruction of melanocytes in vitiligo
- Autoimmune (activated Lymphocytes destroy melanocytes )- neurogenic hypothesis
- self-destruct hypothesis (destruction of melanocytes by a toxic subestance produced by normal melanocytes )
:causes
onset of vitiligo- physical trauma (Koebner phenomenon)
- Illness- emotional stress
- Sunburn
Introduction
The disease appears symmetrically, usually in the face, but also on the nape of neck, axillae, elbows, hands, knees and genitals. Vitiligo usually occurs in a localized or generalized pattern
The “ lip-tip ” pattern involves the skin around the mouth as well as on distal fingers and toes; lips, nipples, genitalia and anus may be involved.
Clinical Presentation
Skin Lesions
-Macules, 5 mm to 5 cm“ -Chalk” or pale white
-sharply marginated -Margins are convex
Trichrome vitiligo)three colors: white, light brown, dark brown(
Inflammatory vitiligo has an elevatederythematous margin and may be pruritic.
Clinical Presentation
Vitiligo: face Extensive depigmentation of the central face. Involved vitiliginous skin has convex
Vitiligo: knees Depigmented, sharply demarcated macules on the knees .
The focal type : is characterized by one or several macules in a single site
Generalized vitiligo: is more common and is characterized by widespread distribution of depigmented macules, often in a remarkable symmetry
vitiligo universalis : extensive generalized vitiligo may leave only a few normally pigmented areas of skin
Segmental Vitiligo : usually develops in one unilateral region ; usually does not extend beyond that initial onesided region
Distribution
Mucosal Vitiligo: depigmentation of only the mucous membranes
Acrofacial Vitiligo: fingers and periorificial areas
Universal vitiligo Vitiliginous macules have coalesced to involve all skin sites with complete
General Examination :Associated with
thyroid disease: (Hashimoto thyroiditis, Graves disease)diabetes mellituspernicious anemiaAddison diseaseMultiple endocrinopathy syndrome
Ophthalmologic examination
healed chorioretinitis or iritisVision is unaffected
The Vogt-Koyanagi-Harada syndrome: is vitiligo + poliosis + uveitis + dysacusis + alopecia areata.
Examination
-Wood Lamp Examination
-Dermatopathology
-Electron Microscopy
-Laboratory Studies
• Thyroxine (T 4 ) • TSH • FBG • CBC
• ACTH stimulation test
Laboratory Examination
Normally, diagnosis of vitiligo can be madereadily on clinical examination of a patient withprogressive, acquired, chalk-white, bilateral
)usually symmetric ,(sharply defined maculesin typical sites.
Diagnosis
Sunscreens : - protection from acute sunburn reaction - limitation of tanning of normally pigmented skin.
Cosmetic Coverup : (called self-tanning agents, which contain Dihydroxyacetone)The objective is to hide the white macules so that the vitiligois not apparent
Repigmentation : The objective is the permanent return of normal melanin pigmentation.
•Topical glucocorticoids
• Topical calcineurin inhibitors • Topical photochemotherapy
• Systemic photochemotherapy • Narrow-band UVB
• Excimer laser (308 nm)
Management
Minigrafting: may be a useful technique for refractory and stable segmental vitiligo macules.
- PUVA may be required after the procedure to unify the color between the graft sites
Depigmentation: The objective of depigmentation is “one” skin color in patients with:
- extensive vitiligo - failed PUVA - who cannot use PUVA
- who reject the PUVA option.
• Bleaching of normally pigmented skin with monobenzylether of hydroquinone 20% (MEH) cream is a permanent, irreversible process.
Management
note that the depigmentation achieved is permanent!!
Vitiligo: therapy-induced repigmentation This 20-year-old Indian female is being treated with photochemotherapy (PUVA).
Before After
In the above case of Vitiligo, initially a medicine was selected (Merc.sol.) basing upon the totality of symptoms and analyzing the case but the patient did not show any improvement after taking that medicine. The patient discontinued treatment thereafter and again came back after one year with depigmented patches but this time it was found intensified although he did not use any other medicine and medication during this
period .
The case was re-analysed taking the presenting totality and Sulphur was the medicine selected.
Sulphur in 30C potency, single dose was prescribed.The patient improved markedly with this remedy withvery few repetitions (2 doses of Sulphur 30) followed by placebo in a very short period. The depigmented spots on his face were almost completely disappeared and regimentation marked on the neck. The patient has been continuing Placebo till
date with steady improvement
Conclusion
THANK YOU
!! ^_^
