Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes, and it is characterized by circumscribed depigmented macules and patches. Vitiligo is a progressive disorder in which some or all of the melanocytes in the affected skin are selectively destroyed. Vitiligo affects 0.5-2% of the world population, and the average age of onset is 20 years.
The most common form of vitiligo is an amelanotic macule or patch surrounded by healthy skin. The macules are chalk or milk-white in color, and lesions are well demarcated.
The lesions are not readily apparent in lightly pigmented individuals; however, they are easily distinguishable with a Wood lamp examination.
Symptoms of Vitiligo
Vitiligo manifests as acquired white or hypopigmented macules or patches. The lesions are usually well demarcated, and they are round, oval, or linear in shape. The borders may be convex. Lesions enlarge centrifugally over time at an unpredictable rate. Lesions range from millimeters to centimeters in size. Initial lesions occur most frequently on the hands, forearms, feet, and face, favoring a perioral and periocular distribution.
Vitiligo lesions may be localized or generalized, with the latter being more common than the former. Localized vitiligo is restricted to one general area with a segmental or quasidermatomal distribution. Generalized vitiligo implies more than one general area of involvement. In this situation, the macules are usually found on both sides of the trunk, either symmetrically or asymmetrically arrayed.
The most common sites of vitiligo involvement are the face, neck, and scalp see different vitiligo pictures. Many of the most common sites of occurrence are areas subjected to repeated trauma, including the following:
-- Bony prominences
-- Extensor forearm
-- Ventral wrists
-- Dorsal hands
-- Digital phalanges
Involvement of the mucous membranes is frequently observed in the setting of generalized vitiligo. Vitiligo often occurs around body orifices such as the lips, genitals, gingiva, areolas, and nipples.
Body hair (leukotrichia) in vitiliginous macules may be depigmented. Vitiligo of the scalp usually appears as a localized patch of white or gray hair, but total depigmentation of all scalp hair may occur. Scalp involvement is the most frequent, followed by involvement of the eyebrows, pubic hair, and axillary hair, respectively. Leukotrichia may indicate a poor prognosis in regard to repigmentation. Spontaneous repigmentation of depigmented hair in vitiligo does not occur.
Some other less common signs of vitiligo may include:
-- Premature whitening (leukotrichia) or graying of the hair on scalp, eyelashes, eyebrows or beard. Vitiligo of the
scal pusually appears as a localized patch of white or gray hair, but total depigmentation of all scalp hair may
occur. Scalp involvement is the most frequent, followed by involvement of the eyebrows, pubic hair, and axillary
-- Loss of pigment of the mucous membranes
-- Loss or change in color of the retina (the inner most layer of eye)