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KEY POINTS
Vitiligo has an equal incidence in all types of skin color.
Given the contrast between the depigmented patches and an individual’s normal skin tones, this disease is most disfiguring for those with darker skin of color.
Between 20% and 30% of patients report the disease in first- and second-degree relatives.
In vitiligo, an absence of melanocytes is the predominant histologic change.
The popular pathogenetic mechanisms for vitiligo include autoimmune, genetic, neural, biochemical, and autocytotoxic causes.
Vitiligo patients have an increased frequency of other autoimmune disorders, including Hashimoto thyroiditis, Graves disease, pernicious anemia, and Addison disease.
Baseline laboratory tests should include a comprehensive metabolic panel, and thyroid function, antinuclear antibody, and thyroid peroxidase antibody tests.
The therapeutic objectives should include both the stabilization and repigmentation of the vitiliginous lesions.
The therapies for limited areas of involvement include topical steroids, topical immunomodulators, calcipotriol, and targeted phototherapy.
For patients with vitiligo affecting more than 15% to 20% of their body’s surface area, optimal results can be achieved with narrow-band ultraviolet B phototherapy.
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Vitiligo is a relatively common acquired pigmentary disorder characterized by areas of depigmented skin resulting from the loss of epidermal melanocytes. Given the stark contrast between the depigmented patches and normal skin, this disease is most disfiguring in patients with darker skin of color [Figure 49-1]. Vitiligo is one of the most psychologically devastating skin diseases, and the psychological effects are influenced and exacerbated by societal perceptions of skin disfigurement and irregularities in skin color.1,2 Patients with vitiligo often experience low self-esteem, isolation, job discrimination, stigmatization, depression, and embarrassment in social and sexual relationships.3
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EPIDEMIOLOGY AND CLINICAL MANIFESTATIONS
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The prevalence of vitiligo varies from 0.1% to 3% in various populations worldwide.4 The onset may occur at any age; however, the peak incidence is during the second and third decades of life. One-fourth of patients with vitiligo are children. Although females are affected more often than males, the disease shows no racial or socioeconomic predilection. Vitiliginous lesions are typically asymptomatic, depigmented macules and patches that have no clinical signs of inflammation, although, at times, inflammatory vitiligo with erythematous borders has been reported. Hypopigmented and depigmented lesions may coexist in a vitiligo patient. Occasionally, the depigmented patches are pruritic. The macules or patches of vitiligo frequently begin on sun-exposed or periorificial facial skin and either remain localized or develop on other cutaneous sites. The areas of depigmentation vary in size from a few millimeters to many centimeters, and their borders are usually distinct. Trichrome lesions are observed most often in individuals with darker skin of color. These lesions are characterized by zones of white, light-brown, and normal skin. Depigmented hair strands are ...