Vitiligo is an acquired pigmentary disorder of the skin that is characterized by circumscribed, depigmented macules and patches. The condition is frequently associated with disorders of autoimmune origin, with thyroid abnormalities being the most common.
#Sign and symptoms:-
White or depigmented macules and patches
Usually well demarcated
Round, oval, or linear in shape
Borders may be convex
Range from millimeters to centimeters in size
Enlarge centrifugally over time at an unpredictable rate
Trichrome vitiligo
Marginal inflammatory vitiligo
Quadrichrome vitiligo
Koebner phenomenon: Development of vitiligo in sites of specific trauma, such as a cut, burn, or abrasion.
Although the diagnosis of vitiligo generally is made on the basis of clinical findings, biopsy is occasionally needed for differentiating vitiligo from other hypopigmenting or depigmenting disorders.
Microscopic examination of involved skin shows a complete absence of melanocytes in association with a total loss of epidermal pigmentation. Superficial perivascular and perifollicular lymphocytic infiltrates may be observed at the margin of vitiliginous lesions, consistent with a cell-mediated process destroying melanocytes.
Other documented histologic findings include the following:
-Degenerative changes in keratinocytes and melanocytes in the border lesions and adjacent skin
-Increased numbers of Langerhans cells
-Epidermal vacuolization
-Thickening of the basement membrane.
Loss of pigment and melanocytes in the epidermis is highlighted by Fontana-Masson staining and immunohistochemistry testing.
Nonsurgical treatment
Phototherapy: Induces satisfactory repigmentation in the majority of patients with early or localized disease
Topical corticosteroids and topical calcineurin inhibitors can be used separately or in combination
Laser therapy: Effective on limited, stable patches of vitiligo
Depigmentation therapy: If vitiligo is extensive and attempts at repigmentation have not produced satisfactory results, depigmentation may be attempted in very carefully selected patients
Micropigmentation: Tattooing can be used to repigment depigmented skin in dark-skinned individuals
#Surgical managment:-
The basic types of repigmentation surgery include the following:
Noncultured epidermal suspensions
Thin dermoepidermal grafts
Suction epidermal grafting
Punch minigrafting
Cultured epidermis with melanocytes or cultured melanocyte suspensions.