Vitiligo is a common skin condition characterized by loss of pigment cells called melanocytes, resulting in chalky white patches on the skin. It affects around 0.5-2% of the population worldwide and has no known cause, though it may be related to an autoimmune response or genetic factors. The patches of depigmentation are well-defined, often appear on areas exposed to the sun like the face and hands, and may worsen with sun exposure. Treatment options include PUVA therapy which uses psoralen drugs and ultraviolet light to stimulate repigmentation, topical corticosteroids to reduce inflammation, and camouflage creams to hide patches.

1. VITILIGO
DR. BIJAY KR.YADAV
Holly vision technical campus
Shankhamul, Kathmandu

2. Vitiligo

3. DEFINITION
Vitiligo is a common, acquired, idiopathic discoloration of the skin
characterized by well circumscribed chalky white colored macules,
which are flushed to skin surface in contrast to leukoderma where a
cause of such change is known.
There is destruction of Melanocytes in localized area of skin which is
caused by immunological mechanism.
Leukoderma is the term applied only to depigmented patches of
known causes eg: following burns, chemicals, inflammatory disorder.
 Vitiligo - 0.5 to 2% of the population worldwide.
 both sexes and in all races
 Vitiligo has a genetic background; >30% of affected individuals
have reported vitiligo in a parent, sibling or child

4. AETIOPATHOGENESIS
 Exact cause is unknown
 Involves focal area of melanocyte loss
 Positive family history of the disorder
 Associated with autoimmune disease such as DM,
Thyroid disorder, Adrenal disorder & Pernicious
anemia ( vit-B12 deficiency)
 Trauma & sunburn may precipitate the appearance
of vitiligo.

5. CLINICAL FEATURES
 Sharply defined areas of depigmentation appear.
 Increase in summer time, when the surrounding skin becomes slightly sun
burn.
 Often start in childhood
Macule of Vitiligo:
 Round, oval
Milky white

6. CLASSIFICATION
 Localized
 Focal - One or more macules in 1 area.
 Segmental - One or more macules in a dermatomal pattern
 Mucosal - Mucus membrane alone
 Generalized
 Acrofacial - Distal extremities and face
 Vulgaris - Scattered macules
 Mixed - Acrofacial and vulgaris involvement, or segmental and acrofacial
and/or vulgaris involvement
 Universal - Complete or nearly complete depigmentation

8. VITILIGO VULGARIS
 COMMON PATTERN
 symmetrical

9. SEGMENTAL VITILIGO
 Unilateral macules in a
dermatomal
 early age of onset
 patches of white hair, known
poliosis

10. UNIVERSAL VITILIGO
 Applies to cases where
the entire body surface is
depigmented

11. ACROFACIAL VITILIGO
 Type affecting the distal fingers and
the facial orifices

12. MUCOSAL VITILIGO

13. MANAGEMENT
1. Psoralens 0.6 mh/kg is adequate to produce repigmentation,
After oral administration maximum concentration of the photosensitizing
drug in the blood is achieved after two hours.
Maximum UVA radiation from sunlight is available between 9 to 11 A.M
Thus to induce maximum photosensitization, it is advisable to take psoralen
in the recommended dose after breakfast followed by exposure of the
macule to sunlight at 11 A.M
Initially exposed for 15 minutes
Then exposure time is gradually increased to a maximum of 45 minutes

14. PUVA (PSORALEN + UVA) THERAPY
 Drug + light
 Systemic/ Topical
Psoralen + UVA (320-400nm)
UVA chamber, PUVASOL
Photometer to measure output

15. PSORALEN PHOTOCHEMOTHERAPY
(PSORGLEN & ULTRAVIOLET A THERAPY & PUVA
THERAPY)

16. CUTANEOUS RESPONSE AFTER PUVA THERAPY
 Erythema
 Perifollicular pigmentation

17. 2. Topical corticosteroids :
 fluorinated steroid & clobetasol propionate 0.5% cream (
Beclovate)
3. (Cosmetics ) camouflage creams & covermask:
 It may be used to hide the patch if other modes of therapy
have failed
4. Skingrafting :
 This is done if there is a patch on a exposed area & is
cosmetically disfiguring.