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, alongside conditions like type 1 diabetes, autoimmune adrenal insufficiency, and autoimmune thyroid disease.

📖 About

• Characterised by acquired depigmented patches of skin due to melanocyte destruction.
• May be a benign finding in some individuals but has a strong association with autoimmune disease (15× increased risk).
• Onset is often in childhood or young adulthood, with a chronic and relapsing course.
• In rare cases, it can follow an autosomal dominant inheritance pattern.

🔬 Aetiology & Pathophysiology

• Autoimmune destruction of melanocytes by anti-melanocyte antibodies and autoreactive T-cells.
• Skin biopsy → absence of melanocytes in depigmented patches.
• Genetic predisposition + environmental triggers (stress, trauma, sunburn) play a role.
• Koebner phenomenon: new lesions appear at sites of trauma.

🤝 Associations

• Endocrine: Thyroid disease (Hashimoto’s, Graves’), Addison’s disease, diabetes mellitus, hypoparathyroidism.
• Haematological: Pernicious anaemia (B12 deficiency).
• Dermatological: Alopecia areata, psoriasis, lichen sclerosus.
• Ocular: Uveitis, retinal pigment changes.
• Often seen within autoimmune polyglandular syndromes.

👀 Clinical Features

• Well-demarcated, milky-white depigmented patches of skin.
• Symmetrical distribution common; often affects face, hands, elbows, knees, and genitalia.
• Hyperpigmented borders may surround depigmented patches.
• Hair within affected patches may also turn white/grey (leukotrichia).
• Lesions may become itchy or inflamed after sun exposure.

🧪 Investigations

• Primarily a clinical diagnosis.
• Blood tests for associated autoimmune disease:
  • FBC & B12 → pernicious anaemia.
  • TFTs → autoimmune thyroid disease.
  • U&E & calcium → adrenal / parathyroid involvement.
  • Autoantibody screen → thyroid, adrenal, parietal cell, IF antibodies.
• Wood’s lamp (UV light) examination → patches fluoresce bright white.

💊 Management

• Education & support: chronic condition, variable progression, no risk of skin cancer from vitiligo itself.
• Cosmetic camouflage (make-up, self-tan products) for psychological support.
• Topical corticosteroids or calcineurin inhibitors (e.g., tacrolimus) → early lesions.
• Phototherapy: Narrowband UVB or PUVA may induce repigmentation in some cases.
• Depigmentation therapy (monobenzone) may be considered for extensive disease (>50% body surface area).
• Counselling: high psychological impact; screen for depression, especially in adolescents.
• Regular monitoring for associated endocrine disorders.

🔮 Prognosis

• Unpredictable course: some patients stabilise, others show progressive spread.
• Repigmentation may occur spontaneously but is often incomplete.
• Chronic condition requiring long-term psychological and dermatological support.