12. Vitiligo

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1. Vitiligo DR. BIJAY KR.YADAV Holly vision technical campus Shankhamul , Kathmandu

2. Vitiligo

3. Definition Vitiligo is a common, acquired, idiopathic discoloration of the skin characterized by well circumscribed chalky white colored macules, which are flushed to skin surface in contrast to leukoderma where a cause of such change is known. There is destruction of Melanocytes in localized area of skin which is caused by immunological mechanism. Leukoderma is the term applied only to depigmented patches of known causes eg : following burns, chemicals, inflammatory disorder . Vitiligo - 0.5 to 2% of the population worldwide. both sexes and in all races Vitiligo has a genetic background; >30% of affected individuals have reported vitiligo in a parent, sibling or child

4. Aetiopathogenesis Exact cause is unknown Involves focal area of melanocyte loss Positive family history of the disorder Associated with autoimmune disease such as DM, Thyroid disorder, Adrenal disorder & Pernicious anemia ( vit-B12 deficiency) Trauma & sunburn may precipitate the appearance of vitiligo .

5. Clinical features Sharply defined areas of depigmentation appear. Increase in summer time, when the surrounding skin becomes slightly sun burn. Often start in childhood Macule of Vitiligo: Round, oval Milky white

6. C lassification Localized Foca l - One or more macules in 1 area. Segmental - One or more macules in a dermatomal pattern Mucosal - Mucus membrane alone Generalized Acrofacial - Distal extremities and face Vulgaris - Scattered macules Mixed - Acrofacial and vulgaris involvement, or segmental and acrofacial and/or vulgaris involvement Universal - Complete or nearly complete depigmentation

7. Vitiligo VULGARIS COMMON PATTERN symmetrical

8. Segmental Vitiligo Unilateral macules in a dermatomal early age of onset patches of white hair, known as poliosis

9. Universal Vitiligo Applies to cases where the entire body surface is depigmented

10. Acrofacial Vitiligo Type affecting the distal fingers and the facial orifices

11. Mucosal vitiligo

12. Management Psoralens 0.6 mh /kg is adequate to produce repigmentation , After oral administration maximum concentration of the photosensitizing drug in the blood is achieved after two hours. Maximum UVA radiation from sunlight is available between 9 to 11 A.M Thus to induce maximum photosensitization, it is advisable to take psoralen in the recommended dose after breakfast followed by exposure of the macule to sunlight at 11 A.M Initially exposed for 15 minutes Then exposure time is gradually increased to a maximum of 45 minutes

13. PUVA ( psoralen + UVA) therapy Drug + light Systemic/ Topical Psoralen + UVA (320-400nm) UVA chamber, PUVASOL Photometer to measure output

14. Psoralen photochemotherapy (Psorglen & Ultraviolet A Therapy & PUVA therapy)

15. Cutaneous response after PUVA therapy Erythema Perifollicular pigmentation

16. Topical corticosteroids : fluorinated steroid & clobetasol propionate 0.5% cream ( Beclovate ) (Cosmetics ) camouflage creams & covermask : It may be used to hide the patch if other modes of therapy have failed Skingrafting : This is done if there is a patch on a exposed area & is cosmetically disfiguring.