Pigmentary Disorders

Question 1

Define vitiligo

Answer 1

complete loss of skin pigmentation

Question 2

What is the etiology of vitiligo?

Answer 2

1. Is due to a loss of epidermal melanocytes
   Exact cause is unknown (?anti-melanocyte AB’s)
2. Results in disfiguring depigmented patches
   A. More apparent in darker skin types

Question 3

What is the demographics of vitiligo?

Answer 3

Overall incidence is 1%
Affects all races and sexes equally
Occurs in all age groups (50% before 20yo)
Positive FamHx in 30% of pts

Question 4

What is vitiligo asst. with?

Answer 4

Associated with autoimmune disorders such as thyroid disease and diabetes mellitus

Question 5

What are the sxs of vitiligo?

Answer 5

1. Varied sizes
2. Depigmented and well demarcated
3. Macules/Patchs
4. Focal, Segmental, or Bilaterally arranged
5. Distributed to dorsa of hands, face, axilla, genitalia, or around body openings (eyes, nostrils, mouth, nipples, umbilicus, anus)

Question 6

How is vitiligo diagnosed?

Answer 6

Woods Light

Skin Biopsy

Question 7

What are the 4 types of vitiligo?

Answer 7

1. Focal
2. Unilateral/Segmental
3. Bilateral/Vulgaris
4. Universalis

Question 8

What is the treatment for vitiligo?

Answer 8

1. Sun Protection!!!
2. Cosmetic Coverup
   A. Camoflaging (Dermablend)
   B. Sunless tanning lotions
   C. Topical Dyes (VitaDye)
3. Topicals
   A. High to Super potent TCS
   B. New TIM’s under study
4. Phototherapy – Most Effective
   A. PUVA or nb-UVB
   B. X-trac Laser
5. Depigmentation
   A. >40% BSA
   B. Monobenzone (Benoquin crm)

Question 9

What is the most effective treatment for vitiligo?

Answer 9

Phototherapy: PUVA or nb-UVB

X-trac Laser

Question 10

What is postinflammatory hypopigmented skin?

Answer 10

1. Normal # of Melanocytes but
   Decreased production
   of Melanin.
   A. Lighter than skin color

Question 11

What is postinflammatory hyperpigmented skin?

Answer 11

1. Normal # of Melanocytes but
   Increased production of Melanin.
   A. Darker than skin color