Vitiligo physical examination: Difference between revisions

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Latest revision as of 20:40, 28 July 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2], Jesus Rosario Hernandez, M.D. [3]

Overview

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.

Physical Examination

Skin

Irregular pale nonscaling macules of skin with different sizes are present. These may be distributed under 5 general patterns:^[1]

Bilaterally distributed, in a symmetrical manner, located on the trunk, face and extremities.
Segmentally distributed, occupying one whole side of the body or simply one single site.
Acrofacially distributed, located in areas such as: perioral area, lips, hands and feet.
Universally distributed when occupying more than half of the body surface area.
Mixed distribution, combining different patterns described above.

In some occasions the limits of these lesions may be erythematous. Also, hair and mucous membranes are often affected, appearing hypopigmented.

After adequate evaluation of the skin of vitiligo patients, the hypopigmented lesions should also be evaluated in a dark room, under the Wood's light. This is a source of UVA light that allows the evaluation of the skin areas with depigmentation, enhancing the details and tones of these areas. Areas such as axillae and genitalia should be evaluated carefully, since these are frequently involved regions that may be missed without this test.^[2]

According to the type of vitiligo presented by the patient, there may be different findings on the physical examination, which may be considered characteristic of that specific type of the disease. These may include:^[3]

Type A, Nonsegmental or Generalized

Nondermatomal distribution.
Higher frequency.
May occur at any age group.
Progressive onset with lifelong evolution.
Association with halo nevus.
Presence of Koebner phenomenon.
Commonly associated with immunologic diseases.

Type B or Segmental

Dermatomal distribution.
Lower frequency.
Higher predominance on younger ages.
Rapid onset and spread, usually within one year.
Absence of association with halo nevus.
Absence of Koebner phenomenon.
Absence of association with immunologic diseases.

Gallery

Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]
Vitiligo. Adapted from Dermatology Atlas^[4]

References

↑ Soutor, Carol (2013). Clinical dermatology. New York: McGraw-Hill Education/Lange Medical Books. ISBN 978-0-07-177296-9.
↑ Habif, Thomas (2010). Clinical dermatology a color guide to diagnosis and therapy. Edinburgh: Mosby Elsevier. ISBN 978-0-7234-3541-9.
↑ Habif, Thomas (2010). Clinical dermatology a color guide to diagnosis and therapy. Edinburgh: Mosby Elsevier. ISBN 978-0-7234-3541-9.
↑ ^4.00 ^4.01 ^4.02 ^4.03 ^4.04 ^4.05 ^4.06 ^4.07 ^4.08 ^4.09 ^4.10 ^4.11 ^4.12 ^4.13 ^4.14 ^4.15 ^4.16 ^4.17 ^4.18 ^4.19 ^4.20 ^4.21 ^4.22 ^4.23 ^4.24 ^4.25 ^4.26 ^4.27 ^4.28 ^4.29 ^4.30 "Dermatology Atlas".

[1] Soutor, Carol (2013). Clinical dermatology. New York: McGraw-Hill Education/Lange Medical Books. ISBN 978-0-07-177296-9.

[2] Habif, Thomas (2010). Clinical dermatology a color guide to diagnosis and therapy. Edinburgh: Mosby Elsevier. ISBN 978-0-7234-3541-9.

[3] Habif, Thomas (2010). Clinical dermatology a color guide to diagnosis and therapy. Edinburgh: Mosby Elsevier. ISBN 978-0-7234-3541-9.

[www.atlasdermatologico.com.br-4] 4.00 ^4.01 ^4.02 ^4.03 ^4.04 ^4.05 ^4.06 ^4.07 ^4.08 ^4.09 ^4.10 ^4.11 ^4.12 ^4.13 ^4.14 ^4.15 ^4.16 ^4.17 ^4.18 ^4.19 ^4.20 ^4.21 ^4.22 ^4.23 ^4.24 ^4.25 ^4.26 ^4.27 ^4.28 ^4.29 ^4.30 "Dermatology Atlas".

[1]

[2]

[3]

[4]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Vitiligo}}
-{{CMG}}; {{AE}} {{JS}}
+{{CMG}}; {{AE}} {{JS}}, {{JH}}
 ==Overview==
-Vitiligo is a [[Chronic (medicine)|chronic skin condition]] that causes loss of [[Biological pigment|pigment]], resulting in irregular pale patches of [[skin]].
+Vitiligo is a [[Chronic (medicine)|chronic skin condition]] that causes loss of [[Biological pigment|pigment]], resulting in irregular pale patches of [[skin]] that may be distributed according to different patterns.
 ==Physical Examination==
 ===Skin===
-Irregular pale nonscaling macules of [[skin]] with different sizes are present. These may be distributed under 5 general patterns:<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>
+Irregular pale nonscaling [[macules]] of [[skin]] with different sizes are present. These may be distributed under 5 general patterns:<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>
-#Bilaterally distributed, in a symmetrical manner, located on the trunk, face and extremities.
+#''Bilaterally distributed'', in a symmetrical manner, located on the [[trunk]], [[face]] and [[extremities]].
-#Segmentally distributed, occupying one whole side of the body or simply one single site.
+#''Segmentally distributed'', occupying one whole side of the [[body]] or simply one single site.
-#Acrofacially distributed, located in areas such as: perioral area, lips, hand and feet.
+#''Acrofacially distributed'', located in areas such as: [[perioral]] area, [[lip|lips]], [[hands]] and [[feet]].
-#Universally distributed, when occupying more than half of the body surface area
+#''Universally distributed'' when occupying more than half of the [[body surface area]].
-#Mixed distribution, combining different patterns described above.
+#''Mixed distribution'', combining different patterns described above.
-In some occasions the borders of these lesions may be erythmatous and the hair and mucous membranes are often affected.
+In some occasions the limits of these [[lesions]] may be [[erythematous]]. Also, [[hair]] and [[mucous membranes]] are often affected, appearing hypopigmented.
+After adequate evaluation of the [[skin]] of [[vitiligo]] patients, the hypopigmented [[lesions]] should also be evaluated in a dark room, under the ''Wood's light''. This is a source of [[UVA]] light that allows the evaluation of the [[skin]] areas with [[depigmentation]], enhancing the details and tones of these areas. Areas such as [[axillae]] and [[genitalia]] should be evaluated carefully, since these are frequently involved regions that may be missed without this test.<ref>{{cite book | last = Habif | first = Thomas | title = Clinical dermatology a color guide to diagnosis and therapy | publisher = Mosby Elsevier | location = Edinburgh | year = 2010 | isbn = 978-0-7234-3541-9 }}</ref>
-After adequate evaluation of the [[skin]] of [[vitiligo]] patients, the hypopigmented lesions should also be evaluated in a dark room, under the ''Wood's light''. This is a source of [[UVA]] light that allows the evaluation of the [[skin]] areas with [[depigmentation]], enhancing the details and tones of these areas. Areas such as [[axillae]] and [[genitalia]] should be evaluated carefully, since these are frequently involved regions that may be missed without the test.<ref>{{cite book | last = Habif | first = Thomas | title = Clinical dermatology a color guide to diagnosis and therapy | publisher = Mosby Elsevier | location = Edinburgh | year = 2010 | isbn = 978-0-7234-3541-9 }}</ref>
+According to the type of [[vitiligo]] presented by the patient, there may be different findings on the [[physical examination]], which may be considered characteristic of that specific type of the disease. These may include:<ref>{{cite book | last = Habif | first = Thomas | title = Clinical dermatology a color guide to diagnosis and therapy | publisher = Mosby Elsevier | location = Edinburgh | year = 2010 | isbn = 978-0-7234-3541-9 }}</ref>
+*'''''Type A, Nonsegmental or Generalized'''''
+:*[[Dermatomic area|Nondermatomal]] distribution.
+:*Higher frequency.
+:*May occur at any age group.
+:*Progressive onset with lifelong evolution.
+:*Association with ''[[halo nevus]]''.
+:*Presence of [[Koebner phenomenon]].
+:*Commonly associated with [[Immune-mediated disease|immunologic diseases]].
+*'''''Type B or Segmental'''''
+:*[[Dermatomic area|Dermatomal]] distribution.
+:*Lower frequency.
+:*Higher predominance on younger ages.
+:*Rapid onset and spread, usually within one year.
+:*Absence of association with ''[[halo nevus]]''.
+:*Absence of [[Koebner phenomenon]].
+:*Absence of association with [[Immune-mediated disease|immunologic diseases]].
+==Gallery==
-[[Image:vitiligo.jpg|thumb|left|Vitiligo<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>]]
+<gallery>
-{{clr}}
+Image:Vitiligo_01.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_02.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_03.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_04.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_05.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_06.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_07.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_08.png|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_09.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_10.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_11.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_12.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_14.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_15.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_16.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_17.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_19.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_20.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_21.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_25.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_26.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_27.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_28.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_29.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_33.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_34.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_36.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_38.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_39.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_41.jpeg|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+Image:Vitiligo_42.png|Vitiligo. <SMALL><SMALL>Adapted from ''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487 Dermatology Atlas]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=487/}}</ref></SMALL></SMALL>
+</gallery>
 ==References==
 {{reflist|2}}
+[[Category:Autoimmune diseases]]
 [[Category:Dermatology]]
-[[Category:Autoimmune diseases]]
 [[Category:Pigment disorders]]
 [[Category:Skin diseases]]
-{{WH}}
-{{WS}}