Vitiligo in an urban academic setting*

Background Vitiligo is a depigmenting disease of unknown etiology. A more complete understanding of vitiligo and associated conditions will provide better insight into the etiology and potential treatment options for this condition. We sought to gather information regarding associated conditions and other epidemiologic data on vitiligo. Methods A retrospective chart review was performed of 135 patients with vitiligo seen between July 1, 2002 and June 30, 2005 at an academic medical center. Epidemiologic characteristics were recorded. Results The patient population consisted of 80 women and 55 men with mean age of presentation of 36.8 years and average disease duration of 5.7 years. Vitiligo vulgaris was the predominant type of vitiligo and hypothyroidism was the most common co‐morbidity. Anti‐thyroid peroxidase and anti‐thyroglobulin antibodies were found in 37% and 18% of patients, respectively. The highest proportion of thyroid abnormalities was found in age of onset category 21–30. Anti‐nuclear antibodies were found in 33% of patients. Conclusion The prevalence of anti‐nuclear and anti‐thyroid peroxidase antibodies was higher in our vitiligo study than that reported elsewhere. In addition, autoimmune thyroid disease may be more common in adult‐onset vitiligo.     

Vitiligo treatment options: an evolving scenario

Sequential displays of several treatment options for vitiligo have been scanned from the literature, and are presented here. A few of the medical modalities have been resigned to history, whereas others have become customary in clinical practice. There has also been a recent surge of interest in the surgical treatment of this disease. Accordingly, this has been appraised and summarized. Special attention has been given to prevalent medical modalities so that they may be effectively utilized by those currently in practice.     

Vitiligo

Vitiligo is an acquired skin disorder caused by the disappearance of pigment cells from the epidermis that gives rise to well defined white patches which are often symmetrically distributed. The lack of melanin pigment makes the lesional skin more sensitive to sunburn. Vitiligo can be cosmetically disfiguring and it is a stigmatizing condition, leading to serious psychologic problems in daily life. It occurs worldwide in about 0.5% of the population and it occurs as frequently in males as it does in females. The cause is unknown, but might involve genetic factors, autoimmunity, neurologic factors, toxic metabolites, and lack of melanocyte growth factors. Since a causative (gene) treatment is not (yet) available, current modalities are directed towards stopping progression and to achieving repigmentation in order to repair the morphology and functional deficiencies of the depigmented skin areas. Many treatments have been used for some time; however; there are some new developments: narrowband ultraviolet (UV) B (311nm) therapy, the combination of corticosteroid cream + UVA therapy, and the transplantation of autologous pigment cells in various modalities. In widespread vitiligo, residual pigment can be removed by depigmentation agents. Sunscreens, camouflage products, and good guidance may help the patient cope better with the disease.     

Vitiligo

Vitiligo is characterized by patches of depigmented skin in a localized to generalized distribution. Up to now, vitiligo is not curable and mostly has a chronic and progressive course. The disorder may be part of a polygenic, multifactorial transmitted disease with an increased disposition to autoimmune disorders, which should be screened for. Depending on the age of the patient, the psychological strain, the location, the body surface area involved, and the disease activity, several conservative as well as surgical therapeutic options may be partially successful. How long the induced repigmentation remains and the effect of the available therapeutic options on the natural history of vitiligo remain to be clarified.     

Vitiligo

Vitiligo occurs in Northern Europe in one of 200 people. The disease can cause significant psychological stress for the affected individual. These patients generate and accumulate massive amounts of H₂O₂- and peroxynitrite in the epidermal compartment. Consequently many proteins are oxidized or nitrated, leading in turn to partial or complete loss of functionality. Moreover, presence of DNA damage in the skin as well as in plasma has been shown, while apoptosis is not enhanced. Induction of DNA repair is associated with up-regulated functioning p53 protein. Considering possible genetic predisposition and /or spontaneous mutations, autoimmune reactions in the disease are put forward in the context of oxidative stress. In addition a review of recent and novel treatment modalities including the role of oxidative stress reduction and combined climatotherapy at the Dead Sea in a group are discussed.     

Vitiligo

Vitiligo represents a selective destruction of the melanocytes. It is a relatively common, probably autoimmune disorder that affects people of all backgrounds and both genders. No particular group seems to be preferentially affected. Half of vitiligo patients have an onset before the age of 18 years. In regions where leprosy is endemic, individuals with vitiligo are often stigmatized due to similarities in appearance between the two diseases. We will review this important subject, emphasizing the latest therapeutic advances.     

Vitiligo

Vitiligo is a disease that affects from 1 to 3 per cent of the population. It is characterized by cutaneous white macules that often develop in cosmetically important areas such as the face, the dorsal hands, and the arms. It may be accompanied by ocular abnormalities and a number of associated disorders such as thyroid disease, diabetes, pernicious anemia, and alopecia areata. There is increasing evidence that vitiligo is an autoimmune disease. Although there is as yet no definitive cure, many patients have obtained respectable repigmentation by the use of topical or oral psoralen plus ultraviolet light. When large areas of skin are involved or when the patient is unresponsive to therapy, serious consideration should be given to depigmentation with monobenzone (Benoquin).     

Dermatoglyphics in Vitiligo

One hundred probands of vitiligo were studied for palmar dermatoglyphics, both qualitatively and quantitatively, and were compared with those of 100 phenotypically normal control subjects. Ulnar loop pattern was the most common digital pattern observed in both probands and controls. An increased incidence of whorls and arches in men and women probands, respectively, was found to be statistically significant when compared with those of controls. Simian crease and Sydney line also have been observed in the present study, which has not been previously reported. A statistically highly significant reduction has been observed in total finger ridge count (TFRC) and a-b ridge count in both sexes of vitiligo cases when compared with those of controls. No significant changes was observed in the values of atd angle and position of axial triradius.     

Vitiligo in children

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