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VITILIGO- BACK TO BASICS
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Author:  gmohan [ 26 May 2014 20:07 ]
Post subject:  VITILIGO- BACK TO BASICS

Vitiligo is an acquired, chronic depigmentation disorder characterized by white patches on the skin. It is classified according to its distribution and extent.

Non-segmental vitiligo is the more common form, accounting for 85–90% of people with vitiligo. It has a non-dermatomal distribution and is usually generalised and symmetrical.
Segmental vitiligo is less common than non-segmental vitiligo, but has an earlier onset and affects 30% of children with vitiligo.

It usually has a dermatomal distribution and is usually unilateral and limited to one segment.

Vitiligo is caused by the loss of functioning melanocytes (pigment cells) in the skin, resulting in patches of white skin or hair. Genetic and environmental factors are both thought to be important.

The prevalence of vitiligo in the worldwide population is approximately 0.5%, but this may be an underestimate. The mean age of onset is 20 years of age.
Complications include psychosocial problems (including low self-esteem and relationship difficulties) and hearing problems, which occur more commonly in people with vitiligo than the general population.

For most people with vitiligo, the prognosis for spontaneous repigmentation is poor.

Vitiligo is associated with an increased risk of other autoimmune diseases, which affect about a third of people with vitiligo.

Diagnosis is made on the basis of features in the history and clinical examination.

White (depigmented) patches are typical, with well-demarcated edges which may be smooth or irregular.
On palpation lesions are flat and non-scaly.
Lesions can be localized or generalized, and are often bilateral and symmetrical. They can appear anywhere, but particularly the fingers and wrists, axillae, groin and genitalia, and the skin around the mouth and eyes.
Individual lesions usually enlarge over time and patches may merge.

An alternative diagnosis should be suspected if there is scaling, hardness or swelling, significant inflammation, or scarring.
Common conditions that may be confused with vitiligo include pityriasis versicolor, post-inflammatory hypopigmentation, pityriasis alba, idiopathic guttate hypomelanosis, halo naevus, scarring, and lichen sclerosus and atrophicus.

When assessing someone with vitiligo it is necessary to determine:
Their skin type and ability to tan.
Whether vitiligo is segmental or non-segmental.
What previous treatments have been tried and their effectiveness.
The impact of the condition on quality of life.
The percentage of the body surface that is affected (for people with non-segmental vitiligo).

If vitiligo is non-segmental, a check for other autoimmune diseases should be carried out.

Advice should be offered on avoiding sunbeds and using sun protection.

Treatment depends on whether vitiligo is segmental or non-segmental and, in primary care, may involve:
Referral to a skin camouflage service.
Management of psychosocial complications.
Use of a topical corticosteroid.

Referral to a dermatologist.
Treatment options which may be available in secondary care include topical pimecrolimus or tacrolimus, narrow-band ultraviolet B phototherapy, surgical treatments, and topical depigmentation.

(Differential Diagnosis continued in the next post) Click to View viewtopic.php?f=17&t=446

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