Vitiligo Pathogenesis: Autoimmune Melanocyte destruction Genetic predisposition Oxidative stress Clinical Features: Hypopigmented macules Often symmetrical Can affect any part of the body Can cause significant psychological distress Classification: Segmental: Unilateral Rapid progression Good response to treatment Generalized: Bilateral Slow progression Poor response to treatment Treatment: Topical: Corticosteroids Calcineurin inhibitors Vitamin D analogs Phototherapy: Narrowband UVB PUVA Surgical: Skin grafting Melanocyte transplantation Other: Depigmentation Clinical Features: Hypopigmented macules Often symmetrical Can affect any part of the body Can cause significant psychological distress Classification: Segmental: Unilateral Rapid progression Good response to treatment Generalized: Bilateral Slow progression Poor response to treatment Treatment: Topical: Corticosteroids Calcineurin inhibitors Vitamin D analogs Phototherapy: Narrowband UVB PUVA Surgical: Skin grafting Melanocyte transplantation Other: Depigmentation Clinical Features: Hypopigmented macules Often symmetrical Can affect any part of the body Can cause significant psychological distress Classification: Segmental: Unilateral Rapid progression Good response to treatment Generalized: Bilateral Slow progression Poor response to treatment Treatment: Topical: Corticosteroids Calcineurin inhibitors Vitamin D analogs Phototherapy: Narrowband UVB PUVA Surgical: Skin grafting Melanocyte transplantation Other: Depigmentation **Diagnostics** * Clinical - mostly * If uncertain: - Wood's lamp exam - Lesions appear as well-defined white areas - Demography - Lesions have characteristic poikiloderma, hyperpigmentation & telangiectasia - Skin biopsy & histology - Loss of melanocytes may be seen - Serological markers of autoimmune disease - e.g. ANA, anti-Ro/SSA, anti-La/SSB antibodies **Treatment & Management** * **General measures:** - Sunscreen - mainstay of the cosmetic regimen - Can be used alone for limited disease or in combination with phototherapy * **Limited disease:** - Topical corticosteroids - Topical calcineurin inhibitors - Alternative topical: tacrolimus, pimecrolimus * **Progressive or refractory Disease:** - PUVA phototherapy - Narrowband UVB phototherapy - Eximer laser * **Surgery:** - Split-skin grafts - Punch grafts - Melanocyte transplantation