Vitiligo

Vitiligo is characterized by hypopigmentation of the skin. It is an autoimmune condition that results from melanocyte dysfunction.

Image from Wikimedia Commons.
Available here:http://en.wikipedia.org/wiki/File:Vitiligo2.JPG

Signs and symptoms

-Hypo or depigmented patches that often enlarge and change shape.
-Most prominent on the face, hands and wrists.

Treatment

-UVB phototherapy with or without Psoralen, a material that increases the effect of the UV light. It can be done at home or a few times a week in the clinic.
-Studies have shown that immunomodulators such as topical tacrolimus (Protopic) and pimecrolimus (Elidel) may also cause improvement in some cases, when used with UVB narrowband treatments
-Psoralen and Ultraviolet A light (PUVA) therapy is generally performed in clinic setting.
-Skin camouflage/make up
-Depigmenting with topical drugs like monobenzone, mequinol or hydroquinone may be considered to make the not vitiligous skin appear fairer and uniform. It increases risk of melanoma and consistent sun protection should be advised.

Differential diagnosis

-Pityriasis alba
-Tuberceloid Leprosy
-Post inflammatory hypopigmentation
-Tinea versicolor
-Albinism
-Piebaldism

USMLE pearl: Vitiligo is often associated with other autoimmune diseases including Hashimoto thyroiditis, type I Diabetes Mellitus, Addison's disease, pernicious anemia etc.