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Vitiligo

Pathophysiology
1. Immune-mediated Melanocyte destruction
2. Family History present in up to 30% of patients
3. Occurs equally in men and women
Epidemiology
1. Affects 1% of the population
2. Onset peaks between age 10-30 years (50% occur by age 20 years)
Types
1. Generalized Vitiligo (>10% of body surface area involved)
2. Acral or Acrofacial Vitiligo (tip-lip pattern: face and distal extremities)
3. Localized Vitiligo (stable involvement of a small body area)
4. Segmental Vitiligo (single dermatome or extremity involved - seen more in children)
Signs
1. Sharply demarcated, white, unpigmented Macules 0.5 to 5 cm in size
2. Distribution
  1. Face and neck
  2. Dorsal hands
  3. Genitalia
  4. Intertriginous folds and axillae
  5. Periocular, periumbilical, and perianal areas
Management: General
1. Sun protection is critical (clothing, Sunscreen)
Management: Cosmetic
1. Concealers (e.g. Dermablend)
2. Topical Corticosteroids
  1. Class II-III Topical Corticosteroids (e.g. Betamethasone 0.05% ointment or cream)
3. Phototherapy with Psoralens (PUVA)
4. Depigmentation (indicated for >40% of BSA involvement)
  1. Permanent depigmentation with Monobenzone 20% cream
  2. Requires 6-18 months for full treatment
5. Surgical grafting
  1. May be used for localized, stable lesions
References
1. Njoo (1999) Arch Dermatol 135(12):1514
2. Plensdorf (2009) Am Fam Physician 79(2):109

Vitiligo (C0042900)
Definition (MSH)	A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached.
Definition (CSP)	usually progressive, chronic pigmentary anomaly of the skin manifested by depigmented white patches that may be surrounded by a hyperpigmented border.
Concepts	Disease or Syndrome (T047)
ICD9	709.01
MSH	D014820
English	Vitiligo, VTLG
Spanish	vitiligo
Parent Concepts	Pigmentation Disorders (C0549567), Hypopigmentation disorder (C0162835), Dermatitis (C0011603), Duplicate concept (C1274013)
Sources	COSTAR, CSP, CST, DXP, ICD9CM, LCH, MEDLINEPLUS, MSH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System)