Vitiligo,by Mohammadreza Khademi,GUMS-IRAN

VITILIGO

BY: MohammadrezaKhademiGuilan university-IRAN

Author: Mohammad Reza Khademi -GUMS-Iran

DEFINITION EPIDEMIOLOGY

PATHOGENESISCLINICAL

MANIFEST

DDx TREATMENT


Macule and Patch

Melanocytes dysfunction

Acquired

Progressive

DEFINITION


0.5-2% global population

AGE:

Average age: 20 years

Epidemiology


Multifactorial

Genetically

Environmentally

Forms: Absolute and Relative(DOPA+ melanocyte)

Pathogenesis


Familial and twin studies:

Genetics role in development

Heterogeneous and complex disease

Wide genome linkage analysis:

Lucus and genes involved in

A. Immune and immune sys

genetically


Amelanotic macule and patch in milky- chulk white

surrounded by normal skin

Lesion’s shape: oval , round , irregular , linear

Convex border ,

enlargement centrifugally , rapid or slow

size : mm to cm

Diagnostic aid by 1.Wood’s lamp 2.Tanning

Pruritis in some cases

Most of time Asymptomatic

Clinical features


Develop anywhere, interested in hyper pigmented

area such as :

face , dorsal aspect of hand , nipples , axillary , umbilical , sacral , inguinal and anogenital

Friction, frequent trauma, pressure seen in many sites of common vitiligo

Clinical features Cont.


Facial Vitiligo:

typically involve around eyes and mouth

Extremity Vitiligo:elbows, digits, flexor wrist knee,dorsal ankles ,shins

vitiligo


Acrofacial Vitligo:

preriungual involvement of 1 finger or more

P.S. : extremities‘ distal and face involvement

Scalp vitiligo:1 or more localized patches of white-gray hair which can be scattered

vitiligo


Difficult diagnose of VTligo without

Wood’s lamp in lightly pigmented @:palm soles, lips, oral mucosa.

Leukotrichia of body varies from 10 to >60 %

vitiligo


CLINICAL VARIANTS:

Poctue’

Inflamatory

Blue

Trichrome ,quadri, penta

IKP(Isomorphic Koebner phenomena)

vitiligo


•SEGMENTAL (CHILD>ADULT)

•NON SEGMENTAL

Clinical Classification


segmental


Clinical Classification

LOCALIZED

UNIVERSALGENERALIZEDAuthor: Mohammad Reza Khademi -

GUMS-Iran

Focal:

1 or more macule w/o segmental distribution

Unilateral/Segmental :one or more macules involving a unilateral segment of the body lesions usually stop abruptly at the midline

Mucosal:mucous membranes alone

LOCALIZED


Vulgaris:

scattered patches that are widely distributed

Acrofacial:distal extremities and face

Mixed:various combinations of segmental, acrofacialand/or vulgaris distribution pattern

Generalized


Vulgaris


Acrofacial


Complete or nearly complete depigmentation.

Universal


Un

iver

sal

loca

lize

d

Gen

eral

ized


More than 90% R generalized

Generalized Localized Universal

Insidious

Sun exposure & tanning

Case-by-case unpredictable

Extension by 2 forms1.development of existing 2.new depigmented area

Natural course;usually slowly but can be rapid

Some degree of sun-induced or spontaneous repigmentation not uncommon but complete and stable spontaneous repigmentation is rare.

Course of disease


chemical or drug-induced ( imatinib) leukoderma,

Post inflammatory depigmentation,

the leukodermas associated with melanoma and scleroderma

late stages of treponematosis & onchocerciasis.

stage III halo nevus

A nevus depigmentosus

post inflammataory hypopigmentation,pityriasis versicolor,other cutaneous infections

DDx


The aims :

1.repigmentation2.stabilization of the depigmentation process.

The choice of therapy depends on :extention, location, activity of disease , age, skin type and motivation to undergo treatment.

The effectivity of A treatment needs to 2-3 month

Treatment


Corticosteroids

topical,injection,class

Topical calcineurin inhibitorsTacrolimus,Pimecrolimus

Photo(chemo) therapy:UVB,PUVA,Sunbath

Lasers:Excimer laser and lamp, Helium neon laser,

Treatment


Surgical therapy

resistance /autolog graft

Micropigmentationiron oxide tattoo

Depigmentation

Treatment



ANY QUESTION???

Vitiligo,by Mohammadreza Khademi,GUMS-IRAN

Health & Medicine

Transcript of Vitiligo,by Mohammadreza Khademi,GUMS-IRAN