Internal Medicine

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

Vitiligo 1541

➣associated ocular abnormalities are uveitis, chorioretinitis,

choroidal abnormalities, iritis

differential diagnosis

■chemical leukoderma, leprosy, mycosis fungoides, piebaldism, pityr-

iasis alba, tinea versicolor, tuberous sclerosis, nevus depigmentosus,

idiopathic guttate hypomelanosis, post-inflammatory hypopigmen-

tation

management

General Measures

■workup for associated disorders if indicated

■sunscreen use especially of non-pigmented macules

■cosmetic products to cover up discoloration

specific therapy

■topical glucocorticoids

➣potent glucocorticoids

use for 3 weeks, then stop for 1 week

for nonfacial, nonaxillary, non-groin

➣mild glucocorticoids

face, groin, and axilla, especially in kids

■topical calcineurin inhibitors – tacrolimus or pimecrolimus

■Phototherapy

➣PUVA

➣Topical – isolated small macules 1–2% BSA

1:10–1:100 mixture of 8-MOP in petrolatum or ethanol

apply 30 minutes prior to UVA irradiation

twice a week

➣Systemic – widespread vitiligo in people > 10 years old

8-MOP 1–2 hours prior to UVA 2–3 times per week for 50–100

treatments (not on consecutive days)

50% substantial repigmentation

➣Narrowband UVB phototherapy – either localized (excimer laser)

or generalized therapy may result in repigmentation equal to that

of PUVA therapy.

■Surgical

➣mini-grafting-1–2 mm punch grafts for isolated small macules

■Depigmentation of normally pigmented skin

➣used in extensive vitiligo