Vitiligo is a skin condition where white patches appear on the skin due to the loss of pigment-producing cells. It can affect any area of the body and may be localized or widespread. The cause is unknown but is thought to involve genetic and autoimmune factors. Treatment aims to stop progression or restore pigmentation through sunscreens, topical steroids, phototherapy, or skin grafting. Prognosis is variable but stabilization or slow progression is most common.

1. By: Saba Sadeghpour
vitiligo

2. Objectives
Introduction
Pathophysiology
Symptoms
DDX
Treatment
Simples

3. Introduction
A skin pigmentation disorders that creates smooth,
depigmented white spots on the skin

4. Definition
Vitiligo is a condition of chronic
skin disease in which a loss of
cells that give color to the skin
(melanocytes) results in
smooth, white patches in the
midst of normally pigmented
skin.
*Can also affect the mucous

5. ⚐Autoimmune
⚐Neural hypothesis
⚐Intrinsic defect of melanocytes
⚐Metabolic disorders
Pathophysiology

6. Etiology & Pathogenesis
Genetic
Immune
Trigger factor
⭐︎The cause of vitiligo is unknown

7. Pathogenesis

8. Pathogenesis
Autoimmun
e theory
Neurogeni
c
hypothesi
s
Self-
destruct
hypothesis

9. Classification
Segmental vitiligo
(SV)
Non-segmental vitiligo
(NSV)

10. White or depigmented macules
Round, oval, or linear in shape
Range from mm to cm in size
Border may be convex
Well demarcated usually
Sign and symptoms

11.  Mostly generalized over a large area of the
skin and bilateral .
 Symmetry in the location of the
patches of depigmentation.
 New patches also appear over time and
can be generalized over large portions of
the body or localized to a particular area.
 Can come about at any age.

12. lesscommon
usually develops in one unilateralregion
hasan earlier ageofonset than generalized
vitiligo
Mostly Focalwith somemacules.
It spreadsmuchmore rapidly than NSV
.
itis much more stable/static in course
its association with autoimmune diseases
appearsto be weaker than that of generalized
vitiligo.

13. Generalized
Vitiligo
Universal
Vitiligo
Focal
Vitiligo
Acrofacial
Vitiligo
Mucosal
Vitiligo

14. DDX
✎Vitiligo
✎Postinflammatory hypopimentation
✎Chemically induced
depigmentation
✎Tinea versicolor
✎Depigmentation melanoma
✎Pityriasis alba

15. Vitiligo
:
disorder in which white patches of skin appear on different
parts of the body when the skin no longer forms melanin
Chemically induced depigmentation :
Working with chemicals such as phenols may cause
depigmentation
postinflammatory hypopigmentation :
is a decrease in pigmentation rather than absence.
is associated with a history of antecedent trauma or
inflammation

16. Pityriasis alba is a mild form of eczematous dermatitis that presents
with hypopigmented macules and small patches on the face, and less
frequently on the upper extremities.
Fine scale may be visible.
The disorder is most common in children with an atopic history.
Idiopathic guttate hypomelanosis :
characterized by multiple, small (<6 mm), well-defined, depigmented
macules;
lesions are most frequently found on the forearms and anterior lower
legs
• Usually related to sun exposure and start in leg
Tinea versicolor :
is a superficial fungal infection that can present as hypopigmented
macules
and patches with fine scale .

17. DDX
• Shape of lesions
• Wood lamp
• History
• Pathology

19. Treatment
Purpose of treatment:
 Stop progress
 Restore skin lesions
* No specific treatment is known!

20. Treatment
☁Sunscreen
☁Class 3 steroids
☁UVB/PUVA
☁Healthy skin graft
☁Vit D
☁…

21. T
ests
Electron
Microscopy
Wood Lamp
Examination
Dermatopathology
(skin biopsy)
Laboratory
Studies

22. Historytaking
 Personal
data:
 Name
 Age
 Occupation
 Social status
 Education level.
 Main complaint

23. cont...
History of skin lesions:
 When? ( +sudden or gradual)
 Where? ( +other sites+other lesions +bilateral or
unilateral )
 associatedsymptoms:Is there
 Itching
 Redness(erythema)
 Pain
 What is the distribution of thelesion?
 How the lesion change ?(colour change,scaleor
bleeding )
 Is there acorrelation betweenthe onsetof skin
lesions and any particular event or exposure?

24. cont...
 Past medical history :
 Chronic disease?
 Operation?
 Illnesses( hospitalization)?
 Skin disease?
 Autoimmune disorders?
 Trauma ?
 Sunor Chemical exposure?
 Family medical history of skin disease like
vitiligo ……
 History of medication :
 When ?Dose?
 such asprescription, over-the-counter, orherbal?
 Is it affective?

25. cont...
History of
allergies
Social history
Sexual history
Travel history

26. Case
 He had first seen a spot 2 years ago on
elbows.
 It had gradually spread on both the fingers
,
knees, elbows, and thigh.
 No change in the lesion (no scale or
bleeding )
 No associated symptoms.
 No history of chronic disease , trauma
or chemical exposure.
 Positive family history of vitiligo :
grandfather.
 No history of medications.

27. PE
 Identification ofprimary lesion (s)
 Site
 Size
 Shape
 Arrangement
 Number
 Surface
 Borders/edges
 Distribution
 Colour

28. PrognosisandTreatment
o Vitiligo is a chronic disease. The course is highly variable,
but rapid onset followed by a period of stability or slow
progression is most characteristic.
o There is no cure for vitiligo.
The aim of treatment:
is to reduce the contrast in color between affected and
unaffected skin.

29. cont...
The approaches to the management of vitiligo
are as follows:
 Sunscreens
 Cosmetic Coverup
 Repigmentation
 Depigmentation

30. cont...
Repigmentation
Localized Macules
• Topical glucocorticoids
•Topical calcineurin inhibitors:
Tacrolimus and pimecrolimus.
•Topical photochemotherapy
[topical 8- methoxypsoralen (8-
MOP) and UVA]
• Excimer laser (308 nm) Best results in
Generalized Vitiligo
• Systemic
photochemotherapy:
PUVAtherapy(Psoralen+
UVA)
• Narrow-band UVB, 311
nm.

31. cont...
Depigmentation
The objective of depigmentation is “one” skin color in patients with
extensive vitiligo or in those who have failed or reject other treatments.
Treatments:
• Bleaching of normally pigmented skin with monobenzylether of
hydroquinone 20% (MEH) cream is a permanent, irreversible
process.
• The success rate is >90%.

32. Michael

35.  Vitiligo is a disease in which the
pigment cells
of the skin, melanocytes, are
destroyed in certain areas.
 Vitiligo results in depigmented, or
white,
patches of skin in any location on the
body.
 Vitiligo can be focal and localized to
one area, or it may affect several
different areas on the body.

36. References
 Fitzpatricks Color Atlas and Synopsisof Clinical
Dermatology , 7th
Edition.
 Vitiligo- UpToDate, medscape
 TheMerck Manual.
 ‫درسنامه‬
‫ی‬
‫پوست‬ ‫های‬ ‫بیماری‬

37. Thanks for
your
attention