Model Answer
0 min readIntroduction
Vitiligo is a common acquired pigmentary disorder characterized by the loss of melanocytes, resulting in circumscribed areas of depigmentation. It affects approximately 0.5-2% of the world’s population, irrespective of sex, race, or geographic location. The condition can significantly impact a patient’s psychological well-being due to cosmetic concerns. The presentation described – asymptomatic, chalky white macules and patches without inflammation, particularly on the face and around body orifices – is highly suggestive of vitiligo. Understanding its etiology, clinical features, and management is crucial for effective patient care.
(i) Diagnosis
Based on the clinical presentation, the most likely diagnosis is Vitiligo, specifically the non-segmental type. The characteristic features – asymptomatic, depigmented, chalky white macules and patches, absence of inflammation, and distribution on the face and around body orifices – are all consistent with this diagnosis. A Wood’s lamp examination can be helpful; vitiliginous areas will appear bright white under Wood’s lamp due to the complete absence of melanin. A skin biopsy, though not always necessary, can confirm the diagnosis by demonstrating the absence of melanocytes in the affected skin.
(ii) Associated Findings
Several associated findings can be observed in patients with vitiligo:
- Koebner Phenomenon: The development of vitiligo lesions at sites of trauma, such as scratches, burns, or pressure points.
- Trichrome Effect: A subtle intermediate zone of hypopigmentation between the depigmented macules and the normally pigmented skin.
- Associated Autoimmune Diseases: Vitiligo is frequently associated with other autoimmune conditions, including:
- Hashimoto’s thyroiditis (most common)
- Graves’ disease
- Type 1 diabetes mellitus
- Addison’s disease
- Pernicious anemia
- Autoimmune polyglandular syndrome type 1 & 2
- Ocular Manifestations: Uveitis, choroiditis, and retinal depigmentation can occur, though less common.
- Auditory abnormalities: Some studies suggest a higher prevalence of hearing loss in vitiligo patients.
(iii) Classification of Vitiligo
Vitiligo is broadly classified into two main types:
| Type | Characteristics |
|---|---|
| Non-Segmental Vitiligo (NSV) |
|
| Segmental Vitiligo (SV) |
|
Recent classifications also include mixed vitiligo (combination of both NSV and SV) and localized vitiligo (focal or patchy vitiligo).
(iv) Clinical Course of the Disease
The clinical course of vitiligo is variable and unpredictable.
- Progression: The disease typically begins with small, depigmented macules that gradually enlarge and coalesce. The rate of progression varies significantly between individuals.
- Stabilization: After a period of progression, the disease may stabilize, with no further loss of pigmentation.
- Repigmentation: Spontaneous repigmentation can occur, particularly in areas exposed to sunlight. However, complete repigmentation is rare.
- Psychological Impact: Vitiligo can have a significant psychological impact, leading to anxiety, depression, and social isolation.
- Prognosis: The prognosis is variable. Early onset, extensive involvement, and family history of autoimmune diseases are associated with a poorer prognosis.
The course of segmental vitiligo is generally more predictable, with a rapid progression followed by stabilization within 1-2 years. Non-segmental vitiligo tends to have a more chronic and fluctuating course.
Conclusion
Vitiligo is a challenging dermatological condition characterized by progressive depigmentation. Accurate diagnosis, understanding the associated findings, proper classification, and awareness of the variable clinical course are essential for effective management. While a cure remains elusive, various treatment options are available to slow progression, stimulate repigmentation, and improve the patient’s quality of life. Continued research into the pathogenesis of vitiligo is crucial for developing more targeted and effective therapies.
Answer Length
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