Vitiligo CS-OSPE

Vitiligo CS-OSPE

generalized

Diagnosis:

What is the diagnosis?

• VITILIGO

Description/Clinical Features:

Describe/What in this image supports your diagnosis?

• White plaques depigmentation due to loss of normal melanocytes, well demarcated, gressy hair.

Differential Diagnosis:

What is the differential diagnosis?

1. pityriasis alba
2. pityriasis versicolor

Pathogenesis/Hypothesis:

What is the pathogenesis & what are the different hypothesis?

• Destruction of melanocytes.
• Autoimmune hypothesis
• Autocytotoxic hypothesis
• Neural hypothesis (involving neurotoxin secretions)

Types/Patterns:

What are the (pattern) Types of the disease?

1. Focal
2. Unilateral/Segmented
3. Generalized/Vulgaris
4. Acrofacial
5. Universal

Associated/Co-occurring Diseases:

What are the common diseases to co-occur/associated with vitiligo?

• Myasthenia gravis
• Alopecia areata
• Addison disease
• Autoimmune diseases like DM type 1
• Systemic Lupus Erythematosus (SLE)

Prognosis Factors:

What are the bad prognosis factors?

1. Widely separated (difficult to treat).
2. If the tips are affected (acral) (difficult to treat).

Tests/Investigations:

Tests that can be done?

1. Woods lamp (bright white/ivory whitish)
2. Biopsy.
3. Thyroid function test
4. ANA/Ro/La

Management/Treatment:

How to manage this patient? / What are the treatment options?

1. General Management: Full history, Examination, Education, Sunscreen, Skin camouflage.
2. Topical Therapies:
   • Corticosteroids (e.g., Hydrocortisone is the drug of choice for disease limited to small areas, effective for Repigmentation).
   • Immunomodulators.
   • Outdoor topical psoralen.
3. Phototherapy:
   • PUVA therapy (Repigmentation, used in extensive vitiligo, avoided in children under 12).
   • Narrowband UVB.
   • Excimer laser (308 nm).
   • UVA (320-400 nm), UVA1 (340-400 nm), UVA2 (320-340 nm).
4. Systemic Therapies:
   • Systemic corticosteroids.
5. Surgical Treatment: (Repigmentation)
   • Tissue graft.
   • Implantation of melanocytes.
6. Depigmentation: (Depigmentation)
   • Bleaching agent (for extensive cases of vitiligo).

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An otherwise healthy 24 Y/O women presented with 6 month history of progressive depigmentation on face, trunk, arms and legs. Around 30% body surface involvement.

Vitiligo

1. What is the diagnosis?
   • Vitiligo
2. What is the best treatment option?
   • Narrowband UVB

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Ali is a 30 Y/O teacher develop these skin lesions. Started to appear as small macules then within five months expanded as current patches on the distal and proximal digits & face.

Acrofacial Vitiligo

1. What is the clinical type of disease Ali develop?
   • Acrofacial vitiligo
2. Which of the following diseases Ali has a high liability to develop?
   • Alopecia areata and Addison disease
3. What is the possible treatment?
   • Excimer laser, topical steroids, depigmentation

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Albinism vs Vitiligo

1. What is the condition?
   • Albinism
2. Pathogenesis:
   • Absence of tyrosinase enzyme → no melanin
3. What disease might happen to this patient?
   • SCC

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Vitiligo (Segmental Type)

1. What is the diagnosis?
   • Vitiligo
2. What is the type?
   • Segmental