Makindo Medical Notes

Related Subjects: |Nikolsky's sign |Koebner phenomenon |Erythema Multiforme |Pyoderma gangrenosum |Erythema Nodosum |Dermatitis Herpetiformis |Lichen Planus |Acanthosis Nigricans |Acne Rosacea |Acne Vulgaris |Alopecia |Vitiligo |Urticaria |Basal Cell Carcinoma |Malignant Melanoma |Squamous Cell Carcinoma |Mycosis Fungoides (Sezary Syndrome) |Xeroderma pigmentosum |Bullous Pemphigoid |Pemphigus Vulgaris |Seborrheic Dermatitis |Pityriasis/Tinea versicolor infections |Pityriasis rosea |Scabies |Dermatomyositis |Toxic Epidermal Necrolysis |Stevens-Johnson Syndrome |Atopic Eczema/Atopic Dermatitis |Psoriasis

Vitiligo may be part of the polyglandular autoimmune syndrome, which includes conditions like type 1 diabetes, autoimmune adrenal insufficiency, and autoimmune thyroid disease.

About

• May be a benign finding in some individuals.
• Has a strong association with autoimmune diseases, increasing the risk by 15 times.
• In rare cases, it may follow an autosomal dominant inheritance pattern.

Aetiology

• Involves the presence of anti-melanocyte antibodies, which target and destroy melanocytes (the cells responsible for skin pigmentation).
• Biopsy of affected areas reveals absent melanocytes in the epidermis.

Associations

• Vitiligo is commonly associated with other autoimmune disorders, including:
• Thyroid disease (e.g., Hashimoto's thyroiditis, Graves' disease)
• Addison's disease (adrenal insufficiency)
• Pernicious anaemia (due to B12 deficiency)
• Alopecia areata (patchy hair loss)
• Other associations include uveitis, diabetes mellitus, and hypoparathyroidism.

Clinical Features

• Characterized by acquired patches of depigmented skin that can vary in size and location.
• The border of these depigmented areas may appear hyperpigmented (darker than the surrounding skin).
• Hairs within depigmented patches are often also depigmented (white or grey).
• Vitiligo lesions may develop at sites of skin trauma, known as the Koebner phenomenon.
• In some cases, sun exposure may cause these areas to become itchy or irritated.

Investigations

• Blood tests to evaluate potential underlying autoimmune conditions, including:
• Full blood count (FBC) and vitamin B12 levels to check for pernicious anaemia.
• U&E, Calcium, and Thyroid function tests (TFTs) as indicated to assess metabolic and endocrine status.
• Screening for specific auto-antibodies, such as thyroid, adrenal, intrinsic factor (IF), and parietal cell antibodies.

Management

• Management is often supportive and focused on improving cosmetic appearance and controlling disease progression:
• Cosmetic camouflage using skin-matching creams to cover depigmented areas.
• Psoralen + UVA (PUVA) therapy to stimulate repigmentation in some cases.
• Topical steroids to reduce inflammation and possibly induce repigmentation in early lesions.