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==Overview== | ==Overview== | ||
[[Vitiligo]] is an [[asymptomatic]] disease that commonly presents during the second decade of life, with a gradual [[depigmentation]] over time.<ref>{{cite book | last = Soutor | first = Carol | title = Clinical dermatology | publisher = McGraw-Hill Education/Lange Medical Books | location = New York | year = 2013 | isbn = 978-0-07-177296-9 }}</ref><ref name="TaïebPicardo2007">{{cite journal|last1=Taïeb|first1=Alain|last2=Picardo|first2=Mauro|title=The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force|journal=Pigment Cell Research|volume=20|issue=1|year=2007|pages=27–35|issn=0893-5785|doi=10.1111/j.1600-0749.2006.00355.x}}</ref> | |||
[[ | ==History== | ||
In the patient presenting for the first time with patches of [[skin]] [[depigmentation]], a thorough history and [[physical examination]] should be performed, including examination under the ''Wood's lamp'' in order to rule out other potentially life-threatening disorders. The initial onset of the condition may be abrupt, however, afterwards it usually progresses slowly, with expansion of [[skin]] [[depigmentation]] with no concomitant [[symptoms]].<ref name="TaïebPicardo2009">{{cite journal|last1=Taïeb|first1=Alain|last2=Picardo|first2=Mauro|title=Vitiligo|journal=New England Journal of Medicine|volume=360|issue=2|year=2009|pages=160–169|issn=0028-4793|doi=10.1056/NEJMcp0804388}}</ref><ref>{{cite book | last = Soutor | first = Carol | title = Clinical dermatology | publisher = McGraw-Hill Education/Lange Medical Books | location = New York | year = 2013 | isbn = 978-0-07-177296-9 }}</ref><ref name="pmid831622">{{cite journal| author=Howitz J, Brodthagen H, Schwartz M, Thomsen K| title=Prevalence of vitiligo. Epidemiological survey on the Isle of Bornholm, Denmark. | journal=Arch Dermatol | year= 1977 | volume= 113 | issue= 1 | pages= 47-52 | pmid=831622 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=831622 }} </ref><ref name="pmid10651958">{{cite journal| author=Boisseau-Garsaud AM, Garsaud P, Calès-Quist D, Hélénon R, Quénéhervé C, Claire RC| title=Epidemiology of vitiligo in the French West Indies (Isle of Martinique). | journal=Int J Dermatol | year= 2000 | volume= 39 | issue= 1 | pages= 18-20 | pmid=10651958 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10651958 }} </ref> It is important to inquire about history of occupational exposures, since those may aggravate underlying [[vitiligo]] [[lesions]] or may lead to [[depigmentation]] areas, with no connection to the disease.<ref name="pmid15140065">{{cite journal| author=Boissy RE, Manga P| title=On the etiology of contact/occupational vitiligo. | journal=Pigment Cell Res | year= 2004 | volume= 17 | issue= 3 | pages= 208-14 | pmid=15140065 | doi=10.1111/j.1600-0749.2004.00130.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15140065 }} </ref> There may be two major subdivisions of [[vitiligo]] which may influence the presence of different characteristics and the [[natural history]] of the disease. They may be present individually or concomitantly, in which case the segmental [[lesions]] will respond poorly to the treatment.<ref name="TaïebPicardo2009">{{cite journal|last1=Taïeb|first1=Alain|last2=Picardo|first2=Mauro|title=Vitiligo|journal=New England Journal of Medicine|volume=360|issue=2|year=2009|pages=160–169|issn=0028-4793|doi=10.1056/NEJMcp0804388}}</ref><ref name="pmid12859615">{{cite journal| author=Gauthier Y, Cario Andre M, Taïeb A| title=A critical appraisal of vitiligo etiologic theories. Is melanocyte loss a melanocytorrhagy? | journal=Pigment Cell Res | year= 2003 | volume= 16 | issue= 4 | pages= 322-32 | pmid=12859615 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12859615 }} </ref> | |||
== | ===Generalized or Nonsegmental=== | ||
*Common later onset. | |||
*Continuous progression with periods of exacerbation. | |||
*[[Hair]] is usually affected later in life. | |||
*Frequently occurs in areas of the [[body]] susceptible to [[trauma]] or keen to pressure. | |||
*Individual or family history of other [[autoimmune diseases]]. | |||
*Bad response to [[autologous]] [[grafting]], commonly recurring on the same location. | |||
*The most common form of the disease, present in about 85-90% of the cases. | |||
===Segmental=== | |||
*Commonly has an earlier onset in [[childhood]]. | |||
*Has an abrupt onset, stabilizing afterwards. | |||
*Rapidly moves to involve [[hair]] regions. | |||
*Commonly involves the face. | |||
*Generally no other [[autoimmune diseases]] are present. | |||
*Commonly responds well to [[autologous]] [[grafts]]. | |||
*May be confused with ''nevus depigmentosus''. | |||
During the history taking, the patient should be asked about:<ref name="pmid15953063">{{cite journal| author=Mason CP, Gawkrodger DJ| title=Vitiligo presentation in adults. | journal=Clin Exp Dermatol | year= 2005 | volume= 30 | issue= 4 | pages= 344-5 | pmid=15953063 | doi=10.1111/j.1365-2230.2005.01779.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15953063 }} </ref> | |||
*Existence of family members with [[vitiligo]]. | |||
*Personal or family history of earlier hair graying. | |||
*Personal or family history of [[autoimmune disease]]. | |||
*Previous episodes of changes in [[skin pigmentation]]. | |||
*Previous therapy and its [[outcome]] on the course of the disease. | |||
*History of [[trauma]] in the area of the [[skin lesion]]. | |||
*Impact of the disease in patient's daily life. | |||
Considering that ''halo [[nevi]]'' are more common in [[vitiligo]] patients than in the population in general, it is important to discuss personal or [[family history]] of such. This is an important step since existence of multiple ''halo [[nevi]]'', is a common indicator of [[autoimmunity]] against the ''[[nevi]]'', which increases the risk of [[vitiligo]] in the presence of history of disease in the family. It is also important to note the [[skin]] type of the patient.<ref name="pmid7673496">{{cite journal| author=Barona MI, Arrunátegui A, Falabella R, Alzate A| title=An epidemiologic case-control study in a population with vitiligo. | journal=J Am Acad Dermatol | year= 1995 | volume= 33 | issue= 4 | pages= 621-5 | pmid=7673496 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7673496 }} </ref><ref name="GawkrodgerOrmerod2008">{{cite journal|last1=Gawkrodger|first1=D.J.|last2=Ormerod|first2=A.D.|last3=Shaw|first3=L.|last4=Mauri-Sole|first4=I.|last5=Whitton|first5=M.E.|last6=Watts|first6=M.J.|last7=Anstey|first7=A.V.|last8=Ingham|first8=J.|last9=Young|first9=K.|title=Guideline for the diagnosis and management of vitiligo|journal=British Journal of Dermatology|volume=159|issue=5|year=2008|pages=1051–1076|issn=00070963|doi=10.1111/j.1365-2133.2008.08881.x}}</ref> | |||
Since [[vitiligo]] is often associated with other [[autoimmune diseases]], it is important to evaluate the presence of such during the consult: | |||
*[[Addison's disease]]<ref name="pmid14067675">{{cite journal| author=DUNLOP D| title=EIGHTY-SIX CASES OF ADDISON'S DISEASE. | journal=Br Med J | year= 1963 | volume= 2 | issue= 5362 | pages= 887-91 | pmid=14067675 | doi= | pmc=PMC1873052 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14067675 }} </ref><ref>{{cite book | last = Rook | first = Arthur | title = Rook's textbook of dermatology | publisher = Blackwell Science | location = Malden, Mass | year = 2004 | isbn = 0-632-06429-3 }}</ref> | |||
*[[Pernicious anaemia]] | |||
*[[Hyperthyroidism]] and/or [[hypothyroidism]]<ref name="CunliffeHall1968">{{cite journal|last1=Cunliffe|first1=W. J.|last2=Hall|first2=R.|last3=Newell|first3=D. J.|last4=Stevenson|first4=C. J.|title=VITILIGO, THYROID DISEASE AND AUTOIMMUNITY|journal=British Journal of Dermatology|volume=80|issue=3|year=1968|pages=135–139|issn=0007-0963|doi=10.1111/j.1365-2133.1968.tb12282.x}}</ref> | |||
*[[Hypoparathyroidism]] | |||
*[[Diabetes mellitus]]<ref name="pmid5448375">{{cite journal| author=Dawber RP| title=Clinical associations of vitiligo. | journal=Postgrad Med J | year= 1970 | volume= 46 | issue= 535 | pages= 276-7 | pmid=5448375 | doi= | pmc=PMC2467025 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5448375 }} </ref> | |||
*[[Alopecia areata]] | |||
*[[Myasthenia gravis]] | |||
*[[Malignant melanoma]]<ref name="Frenk1969">{{cite journal|last1=Frenk|first1=E.|title=Dépigmentations vitiligineuses chez des patients atteints de mélanomes malins|journal=Dermatology|volume=139|issue=1|year=1969|pages=84–91|issn=1421-9832|doi=10.1159/000253894}}</ref> | |||
==Common Symptoms== | ==Common Symptoms== | ||
Unlike other diseases, [[vitiligo]] does not cause any physical [[symptoms]]. However, the [[depigmentation]] of the [[skin]] might have a [[psychological]] impact on the individual, leading to [[social isolation]] and eventually [[depression]].<ref name="GawkrodgerOrmerod2008">{{cite journal|last1=Gawkrodger|first1=D.J.|last2=Ormerod|first2=A.D.|last3=Shaw|first3=L.|last4=Mauri-Sole|first4=I.|last5=Whitton|first5=M.E.|last6=Watts|first6=M.J.|last7=Anstey|first7=A.V.|last8=Ingham|first8=J.|last9=Young|first9=K.|title=Guideline for the diagnosis and management of vitiligo|journal=British Journal of Dermatology|volume=159|issue=5|year=2008|pages=1051–1076|issn=00070963|doi=10.1111/j.1365-2133.2008.08881.x}}</ref> | |||
== | |||
==References== | ==References== | ||
Latest revision as of 04:14, 26 June 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Vitiligo is an asymptomatic disease that commonly presents during the second decade of life, with a gradual depigmentation over time.[1][2]
History
In the patient presenting for the first time with patches of skin depigmentation, a thorough history and physical examination should be performed, including examination under the Wood's lamp in order to rule out other potentially life-threatening disorders. The initial onset of the condition may be abrupt, however, afterwards it usually progresses slowly, with expansion of skin depigmentation with no concomitant symptoms.[3][4][5][6] It is important to inquire about history of occupational exposures, since those may aggravate underlying vitiligo lesions or may lead to depigmentation areas, with no connection to the disease.[7] There may be two major subdivisions of vitiligo which may influence the presence of different characteristics and the natural history of the disease. They may be present individually or concomitantly, in which case the segmental lesions will respond poorly to the treatment.[3][8]
Generalized or Nonsegmental
- Common later onset.
- Continuous progression with periods of exacerbation.
- Hair is usually affected later in life.
- Frequently occurs in areas of the body susceptible to trauma or keen to pressure.
- Individual or family history of other autoimmune diseases.
- Bad response to autologous grafting, commonly recurring on the same location.
- The most common form of the disease, present in about 85-90% of the cases.
Segmental
- Commonly has an earlier onset in childhood.
- Has an abrupt onset, stabilizing afterwards.
- Rapidly moves to involve hair regions.
- Commonly involves the face.
- Generally no other autoimmune diseases are present.
- Commonly responds well to autologous grafts.
- May be confused with nevus depigmentosus.
During the history taking, the patient should be asked about:[9]
- Existence of family members with vitiligo.
- Personal or family history of earlier hair graying.
- Personal or family history of autoimmune disease.
- Previous episodes of changes in skin pigmentation.
- Previous therapy and its outcome on the course of the disease.
- History of trauma in the area of the skin lesion.
- Impact of the disease in patient's daily life.
Considering that halo nevi are more common in vitiligo patients than in the population in general, it is important to discuss personal or family history of such. This is an important step since existence of multiple halo nevi, is a common indicator of autoimmunity against the nevi, which increases the risk of vitiligo in the presence of history of disease in the family. It is also important to note the skin type of the patient.[10][11] Since vitiligo is often associated with other autoimmune diseases, it is important to evaluate the presence of such during the consult:
- Addison's disease[12][13]
- Pernicious anaemia
- Hyperthyroidism and/or hypothyroidism[14]
- Hypoparathyroidism
- Diabetes mellitus[15]
- Alopecia areata
- Myasthenia gravis
- Malignant melanoma[16]
Common Symptoms
Unlike other diseases, vitiligo does not cause any physical symptoms. However, the depigmentation of the skin might have a psychological impact on the individual, leading to social isolation and eventually depression.[11]
References
- ↑ Soutor, Carol (2013). Clinical dermatology. New York: McGraw-Hill Education/Lange Medical Books. ISBN 978-0-07-177296-9.
- ↑ Taïeb, Alain; Picardo, Mauro (2007). "The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force". Pigment Cell Research. 20 (1): 27–35. doi:10.1111/j.1600-0749.2006.00355.x. ISSN 0893-5785.
- ↑ 3.0 3.1 Taïeb, Alain; Picardo, Mauro (2009). "Vitiligo". New England Journal of Medicine. 360 (2): 160–169. doi:10.1056/NEJMcp0804388. ISSN 0028-4793.
- ↑ Soutor, Carol (2013). Clinical dermatology. New York: McGraw-Hill Education/Lange Medical Books. ISBN 978-0-07-177296-9.
- ↑ Howitz J, Brodthagen H, Schwartz M, Thomsen K (1977). "Prevalence of vitiligo. Epidemiological survey on the Isle of Bornholm, Denmark". Arch Dermatol. 113 (1): 47–52. PMID 831622.
- ↑ Boisseau-Garsaud AM, Garsaud P, Calès-Quist D, Hélénon R, Quénéhervé C, Claire RC (2000). "Epidemiology of vitiligo in the French West Indies (Isle of Martinique)". Int J Dermatol. 39 (1): 18–20. PMID 10651958.
- ↑ Boissy RE, Manga P (2004). "On the etiology of contact/occupational vitiligo". Pigment Cell Res. 17 (3): 208–14. doi:10.1111/j.1600-0749.2004.00130.x. PMID 15140065.
- ↑ Gauthier Y, Cario Andre M, Taïeb A (2003). "A critical appraisal of vitiligo etiologic theories. Is melanocyte loss a melanocytorrhagy?". Pigment Cell Res. 16 (4): 322–32. PMID 12859615.
- ↑ Mason CP, Gawkrodger DJ (2005). "Vitiligo presentation in adults". Clin Exp Dermatol. 30 (4): 344–5. doi:10.1111/j.1365-2230.2005.01779.x. PMID 15953063.
- ↑ Barona MI, Arrunátegui A, Falabella R, Alzate A (1995). "An epidemiologic case-control study in a population with vitiligo". J Am Acad Dermatol. 33 (4): 621–5. PMID 7673496.
- ↑ 11.0 11.1 Gawkrodger, D.J.; Ormerod, A.D.; Shaw, L.; Mauri-Sole, I.; Whitton, M.E.; Watts, M.J.; Anstey, A.V.; Ingham, J.; Young, K. (2008). "Guideline for the diagnosis and management of vitiligo". British Journal of Dermatology. 159 (5): 1051–1076. doi:10.1111/j.1365-2133.2008.08881.x. ISSN 0007-0963.
- ↑ DUNLOP D (1963). "EIGHTY-SIX CASES OF ADDISON'S DISEASE". Br Med J. 2 (5362): 887–91. PMC 1873052. PMID 14067675.
- ↑ Rook, Arthur (2004). Rook's textbook of dermatology. Malden, Mass: Blackwell Science. ISBN 0-632-06429-3.
- ↑ Cunliffe, W. J.; Hall, R.; Newell, D. J.; Stevenson, C. J. (1968). "VITILIGO, THYROID DISEASE AND AUTOIMMUNITY". British Journal of Dermatology. 80 (3): 135–139. doi:10.1111/j.1365-2133.1968.tb12282.x. ISSN 0007-0963.
- ↑ Dawber RP (1970). "Clinical associations of vitiligo". Postgrad Med J. 46 (535): 276–7. PMC 2467025. PMID 5448375.
- ↑ Frenk, E. (1969). "Dépigmentations vitiligineuses chez des patients atteints de mélanomes malins". Dermatology. 139 (1): 84–91. doi:10.1159/000253894. ISSN 1421-9832.