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Stark white, well-demarcated macules of varying sizes are noted in five possible patterns.

Generalized-bilaterally symmetrical macules on face, trunk, and extremities (Figures 21-1 and 21-2).

Segmental pattern: Affecting one site or one side of the body.

Acrofacial: Affecting the lips, perioral areas, hands, and feet.

Universal: Involving over 50% of the body surface area over a wide distribution.

Mixed pattern: A combination of generalized, segmen- tal, or acrofacial patterns.

The macules are nonscaling and accentuate with Wood’s lamp examination. Lesions are often symmetric but may occur anywhere with a peculiar predilection for circumferential involvement of orifices, face and upper chest, and sites of pressure. Hair and mucous membranes may also be affected. Only rarely are borders erythematous or hyperpigmented.

Wood’s Lamp Examination. Wood’s lamp is a handheld ultraviolet A irradiation de-

vice that emits at approximately 365 nm. Examination withICWMoodA’sUlTaHmOpRisTabiebst performed in a RcEoTmAKpEletel1yst

REG F FIGURE 2a&b

dark room. The examiner should allow at least 30 sec-

3rd onds for adTIaTpLtEing to the darkness before starting the

CASE EMail

Revised examination. Wood’s lamp pLrionveides b4r-Cight reflection of

Enon ARTIST: mst H/T H/T SIZE white patches and enhanced details on intermediate

FILL Combo 16p6

pigment tones (Panel A), as compared with normal

AUTHOR, PLEASE NOTE:

light (Panel B). Some lamps incorporate a magnifying

Figure has been redrawn and type has been reset.

lens that is useful in evaluating terminal and vellus pig-

Please check carefully.

2nd

mentation of hair. For patients with darker skin types,

Wood’s lamp examination is less useful

Symptoms

Half of people with vitiligo develop patches of de-pigmented skin appearing on extremities before their 20s. The patches may grow, shrink, or remain constant in size. Patches often occur symmetrically across both sides on the body. Occasionally small areas may repigment as they are recolonised by melanocytes. The location of vitiligo affected skin changes over time, with some patches re-pigmenting and others becoming affected.

In some cases, mild trauma to an area of skin seems to cause new patches - for example around the ankles (caused by friction with shoes or sneakers). Vitiligo may also be caused by stress that affects the immune system, leading the body to react and start eliminating skin pigment.

Vitiligo on the scalp may affect the color of the hair (though not always), leaving white patches or streaks. It will similarly affect facial and body hair.

The following list of symptoms mentioned from various sources includes the 23 mentioned below:

• Hand white patches
• Feet white patches
• Arm white patches
• Face white patches
• Lip white patches
• Armpit white patches
• Chest white patches
• Back white patches
• Shoulders white patches
• Groin white patches
• White patches around the mouth
• White patches around the eyes
• Nostril white patches
• Navel white patches
• Genital white patches
• Mucous membrane white patches
• Rectal white patches
• Uveitis
• Retina white patches
• Premature graying
• Gray scalp hair
• Gray eyelashes
• Gray eyebrows
• Gray beard
• Sun sensitivity

Random notes

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