Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1540 Vitiligo

➣all races affected, but darker skin tones more common

➣peak onset 10–30 years

➣21% have affected first-generation family members

■associated disorders

➣thyroid disease, diabetes mellitus, Addison’s disease, pernicious

anemia

Signs & Symptoms

■depigmented, white round to oval macules and patches without sur-

face change

■Predilection for periorificial, acral and genital involvement

■other associated cutaneous findings

➣halo nevi, leukotrichia

➣alopecia areata may be more common in patients with vitiligo

■segmental – unilateral macules in dermatomal pattern

➣more common in children

➣usually nonprogressing

➣nonfamilial, earlier onset

➣not associated with other autoimmune disorders

➣50% associated with poliosis

➣trigeminal area most common site

■generalized – few to many macules and patches

➣most common type

➣extensor surfaces usually symmetric

➣common sites include IP joints, MCP, MTP, elbows, knees, peri-

orificial

■universal – widespread vitiligo with few remaining normal pig-

mented areas

➣associated with multiple endocrinopathy syndrome

tests

Specific Diagnostic Tests

■Diagnosis clinical

■wood’s lamp showing accentuation of sharply bordered macules

Other Tests as Appropriate

■Thyroid panel in patients with generalized or universal vitiligo

■consider work-up for associated diseases if symptomatic

■consider ophthalmologic examination