Pigmentary Disorders (Vitiligo) & Alopecia Areata Flashcards
Describe what vitiligo is and describe its characteristica
Acquired autoimmune, idiopathic disorder characterized by circumscribed depigmented macules (flat, <1cm) and patches (flat, >1cm)
When we see depigmented, it means the complete loss of the pigment which means that the lesions look like whitish macules or patches.
Daha çok distal ekstremitelerde, ellerde
Describe the epidemiological factors of Vitiligo
Ortalama yaş 20. Popülasyonun %1-2’si, M=F, Fiziksel injury, sunburn, emotional injury ve hamilelik tetikleyebilir.
Genetik etkenler olabilir bazı hastalarda. Otoimmün olarak melanosit destrüksiyonu var. Diğer otoimmün hastalıklarla beraber olabilir o yüzden (pernicious anemia, DM tip 1, otoimmün tiroidit, alopecia arreata)
Vitiligo is said to be Koebner pozitif; what does it mean?
Koebner pozitif (appearance of new skin lesions on previously unaffected skin secondary to trauma)
What would you see if you did biopsy in a vitiligo patient?
When we take a biopsy sample we see that the melanocytes are completely or near-completely lost. We can see this lymphocytic infiltration on the upper dermis.
What is the tx of vitiligo?
Tedavi:
a) Topical tacrolimus/pimecrolimus (2 yaş üstünde)
b) Topical corticosteroids (decreases immunities effect against melanocytes)
c) Larger lesions, more widespread disease, topikal tedaviye yanıt yoksa:
i) Narrow band UVB phototherapy/PUVA
ii) Excimer laser/light therapy (larger lesions, more widespread disease, topikal tedaviye yanıt yoksa)
d) En son seçenek:
i) Monobenzyl ether of hydroquinone (widespread cases – complete bleaching)
use clinics+ wood lamp and bx (if needed) for dx
20-30% spontaneous recovery
Sun protection!
Topical steroids
Topical calcineurine inhibitors: tacrolimus, pimecrolimus
Phototherapy (nbUVB, PUVA)
Camouflage
Depigmentation: Hydroquinone
Psychological support
Name other autoimmune diseases that vitiligo is associated with
Increased frequency with alopecia areata, pernicious anemia, DMT1, Hashimoto’s thyroiditis, and Addison’s disease, independent of course
What is the difference btw vitiligo and albanism?
vitiligo -> decrease nb of melanocyte
albinism -> melanocytes do not produce melanin (d/t tyrosine def.)
Name ddx to vitiligo
P. Versicolor alba
Idiopathic guttate hypomelanosis
P. Alba
Early stage of scleroderma
Indeterminate leprosy
Syphilis 2nd stage
Tuberous sclerosis
PIH
Nevus anemicus
Nevus depigmentosus and piebaldism; congenital
Define acrofacial and vulgaris
acrofacial: face and hand
vulgaris: common, usual
What is Alopecia Areata?
A non- scarringcircumscribed alopeciathat is characterized bywell-demarcatedpatchesofhairloss due toimmune-mediatedinflammationofhair follicles
Non-cicatricial hair loss
Autoimmune response to hair follicle
Regional loss of hair
%2
Onset in childhood and young adulthood
Genetics, stress, autoimmune diseases; polygenic
Down syndrome, autoimmune thyroid diseases, atopy, vitiligo
10-20% family history
What are the clinical findings of Alopecia Areata?
Round/oval
Solitary/multiple
Exclamation mark hair on shedding edge
No erythema, scaling or atrophy
Beard, eyebrow, and eyelash
atrophy yok, skar yok, eritem yok,
sadece saclar dökülmüş, kenarında (dermoscope ile baktigimizda) da ünlem işareti saclar var (‘!’)
sadece sac sakal degil, tüm killar etkilenebilir (genital bölge,
koltuk altı.. her yer) cocuklarda izole kirpik dökülmeleri bile olabiliyor
Differentiate alopeciai areata/ totalis/ universalis
areata: patches of hair loss
totalis: no hair on head
universalis: no hair on body
What are poor prognostic criteria of alopecia?
Presence of atopy
Prepubertal onset
Accompanying autoimmune disease
Nail dystrophy
Recurrent disease
Ophiasis
Alopecia universalis
Family history
What is the ddx of alopecia?
T. Capitis
Trichotillomania
Secondary syphilis
Early cicatricial alopecia
What is the tx of alopecia?
Topical steroids
Minoxidil 5%
Anthraline
Difencyprone, SADBE
Intralesional steroid injection (triamnisolon)
Psychological support
Systemic steroids
Immunosuppressives (cyclosporine)
Jak inhibitors (tofacitinib)
