VITILIGO

Dr. Reham Maher Abdel Gaber

Assistant professor of Dermatology, Venereology
& Andrology
Adopted from Prof. Dalia Abdel Aziz
Vitiligo
It is an acquired loss of pigment of the skin characterized by well
circumscribed milky white macules or patches devoid of identifiable
melanocytes.
Vitiligo can affect both sexes.
It occurs in about 1- 3% of the world’s population.
 Aetiology:
1- Inheritance.

2- Autoimmune hypothesis: Antimelanocyte

antibodies  Destruction of melanocytes.

3- Neurogenic hypothesis: Melanocytotoxic

substances released from nerve endings 
Destruction of melanocytes.

4- Self-destruct theory.
Clinical picture:
Age & sex:- it can affect all ages, with no sex
predilection.

Depigmented milky white macules and or patches

surrounded by a normal or a hyperpigmented border.

The hairs in the vitiliginous areas usually become

white also.
 Distribution:
Sun exposed areas such as dorsal surface of hands and
the face, including peri-orificial and peri-orbital areas.
Hyperpigmented areas such as axilla, groin, genitalia,
flexures, and nipple.
Sites of friction and bony prominences like elbows and
knees.
Lesions can appear at sites of trauma to normal skin
(Köbner’s phenomenon).
Vitiligo may involve the entire body surface.
 Variants:
1- Localized: segmental or focal.
2- Generalized.
3- Complete or universal.
N.B: Focal vitiligo characterized
by a limited number of depigmented
macules without segmental distribution.

Another classification
1- stable
2- progressive
Differential Diagnosis:
Partial albinism
The lesions are present at
birth and remain
unchanged throughout
life, and usually confined
to the head and trunk.
Differential Diagnosis:
Hypopigmentation in
pityriasis alba, pityriasis
versicolor and leprosy.
 Treatment:
The use of cosmetic camouflage for the
lesions on the exposed skin.
I) Medical Treatment:

a. Cortecosteroids: Topical and or systemic

steroids.
b. Immunomodulators: topical
immunomodulators such as tacrolimus &
pimecrolimus.
c. Antioxidants.
II) Phototherapy: Stimulates residual
melanocytes in hair follicles.

a. PUVA: Oral or topical Psoralen + UVA.

a. UVB- Narrow band (UVB-NB)

(311 nm): Lamps without psoralen.

III) Surgical: The use of grafting techniques e.g.

minigrafts.

IV) LASER: i.e. ecximer LASER.