Vitiligo overview: Difference between revisions
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==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
The natural history of vitiligo is variable. Depigmentation may be stable or progressive and can cause even a total body depigmentation or remit spontaneously, although spontaneous remission is uncommon. | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 00:00, 26 June 2014
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Vitiligo overview On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Vitiligo (IPA Template:IPA) or leukoderma is a chronic skin condition that causes loss of pigment, resulting in irregular pale patches of skin. The precise cause of vitiligo is complex and not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors. The population incidence in the United States is considered to be 1%.
Historical Perspective
Human pigmentation diseases, as vitiligo, have been described since ancient times by different cultures around the world. Some famous texts, as the Eber Papyrus, Atharva Veda or even the Bible, provide a description of "white spotted-diseases" that could include cases of vitiligo. Celsus was the first to use the word "vitiligo" in the first century A.C. and Moriz Kaposi was one of the first to describe the histophatology features of vitiligo.
Classification
Vitiligo can be classified in two clinical subtypes. One is segmented vitiligo, which affects only 1 segment of the body (face, arm or leg); and non-segmented vitiligo, involving more than 1 segment, such as both knees or both hands.
Pathophysiology
Vitiligo is caused by a loss of skin melanocytes. Although the exact mechanism is not known, at least in some cases, an autoimmune process may play a role. [1][2] The fact that vitiligo is more prevalent in patients with certain autoimmune disorders, such as Addison's disease, hyperthyroidism, alopecia areata and pernicious anemia supports this hypothesis,[3][4][5] but it should also be recognized that the majority of patients with vitiligo do not have any autoimmune disorder.
Causes
Vitiligo is caused by a loss of skin melanocytes. Although the exact mechanism is not known, at least in some cases, an autoimmune process may play a role. [1][2]
Differentiating Vitiligo from other Diseases
There are many conditions that are included in the differential diagnosis of vitiligo, the most common are pityriasis alba, postinflammatory hypopigmentation, tinea versicolor, halo nevus, tuberous sclerosis and albinism.
Epidemiology and Demographics
Vitiligo is the most common human pigmentation disorder, with a prevalence of 1,000/100,000 (1%) of the population. Males and females are equally affected. Half of patients are diagnosed before the age of 20.
Risk Factors
Autoimmune diseases and a family history of vitiligo are considered risk factors for developing this condition. A patient that has a relative with vitiligo has an increased risk of developing the disease and having an earlier onset.
Natural History, Complications and Prognosis
The natural history of vitiligo is variable. Depigmentation may be stable or progressive and can cause even a total body depigmentation or remit spontaneously, although spontaneous remission is uncommon.
Diagnosis
History and Symptoms
Vitiligo is an asymptomatic disease that commonly presents during the second decade of life, with a gradual depigmentation over time.[6][7]
Physical Examination
Vitiligo is a chronic skin condition that causes loss of pigment, resulting in irregular pale patches of skin that may be distributed according to different patterns.
Laboratory Findings
There are no laboratory abnormalities in vitiligo disease. Consideration should be given to ordering laboratory studies to exclude the presence of other associated conditions such as pernicious anemia, Addison's disease and thyroid disease.
Other Diagnostic Studies
The cellular mechanism beneath the vitiligo lesion is the destruction of melanocytes therefore, on an histological study, it will be noted the absence of melanocytes and possibly lymphocytic infiltrates on the periphery of the lesions, consistent with the destruction of melanocytes by the immune system.
Treatment
Medical Therapy
Primary Prevention
Support organizations
Support groups and organizations are available to help people learn more about vitiligo, understand treatment options, and find support from other people with vitiligo.
Vitiligo Support International is the largest vitiligo organization in the world. The nonprofit organization provides free access to online message boards, chat rooms, frequently asked questions, information and articles, as well as a patient-referred doctor search. The group advocates on behalf of patients, conducts patient conferences and has local support groups.
The National Vitiligo Foundation (NVF) is a 501(c)(3) nonprofit organization that provides access to online resources, physician listings, frequently asked questions (etc); funds research through grants and sponsors local support groups and workshop style conferences.
The American Vitiligo Research Foundation Inc. (AVRF) is a non-profit, tax-exempt charity that aims to increase public awareness about vitiligo and to help those affected by vitiligo, focusing specifically on children and their families. It supports finding a cure through alternatives to animal testing.
VITFriends,LLC is a support group in the North East USA. Formed in 2004, VITFriends is still growing and touching the world. We are a web-community offering words of encouragement and sharing hope to individuals dealing with Vitiligo. The goals is to bring public awareness about this condition as we share HOPE.[2]
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 Dell'anna ML, Picardo M (2006). "A review and a new hypothesis for non-immunological pathogenetic mechanisms in vitiligo". Pigment Cell Res. 19 (5): 406–11. doi:10.1111/j.1600-0749.2006.00333.x. PMID 16965269.
- ↑ Shahla Babaee Nejad, Hamideh Herizchi Qadim, Leila Nazeman, Roohollah Fadaii & Mohamad Goldust (2013). "Frequency of autoimmune diseases in those suffering from vitiligo in comparison with normal population". Pakistan journal of biological sciences: PJBS. 16 (12): 570–574. PMID 24494526. Unknown parameter
|month=ignored (help) - ↑ Daniel Holthausen Nunes & Ligia Maria Hademann Esser (2011). "Vitiligo epidemiological profile and the association with thyroid disease". Anais brasileiros de dermatologia. 86 (2): 241–248. PMID 21603806. Unknown parameter
|month=ignored (help) - ↑ Kirsty J. MacLean & Michael J. Tidman (2013). "Alopecia areata: more than skin deep". The Practitioner. 257 (1764): 29–32. PMID 24383154. Unknown parameter
|month=ignored (help) - ↑ 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.