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Dermatology
Vitiligo and Other Disorders of Hypopigmentation
Built from Dermatology, 5th Edition
What’s inside
11 sections · 162 slides
Overview
- What hypopigmentation means
- Two mechanisms of pigment loss
- How leukoderma is diagnosed
- How this deck is organised
Vitiligo
An acquired autoimmune disease that destroys pigment cells, causing depigmented patches.
- Definition and overview
- Epidemiology
- Genetic risk
- Selected susceptibility loci and candidate genes for vitiligo.
- Selected susceptibility loci and candidate genes for vitiligo. (continued)
- Selected susceptibility loci and candidate genes for vitiligo. (continued)
- Selected susceptibility loci and candidate genes for vitiligo. (continued)
- Selected susceptibility loci and candidate genes for vitiligo. (continued)
- How vitiligo begins: the pathogenic pathway
- Pathogenesis of vitiligo
- Memory T cells and relapse
- What a vitiligo patch looks like
- Where vitiligo appears
- Genital vitiligo of the glans penis
- Vitiligo of the wrists and palms
- Palm, sole and mouth involvement
- Body sites favoured by vitiligo
- Classifying vitiligo
- Six clinical subtypes
- Segmental vitiligo of the face
- Subtle segmental vitiligo with eyelash poliosis
- Vitiligo variants
- Inflammatory vitiligo with a raised red border
- Inflammatory vitiligo with a figurate border
- Disease course and activity
- Eye and ear involvement
- Associated autoimmune disease
- APECED and childhood vitiligo
- Pathology
- Histology of vitiligo
- Differential diagnosis
- Goals and general approach
- Perifollicular repigmentation after phototherapy
- Topical corticosteroids
- Topical calcineurin inhibitors and JAK cream
- Light-based therapy
- Oral and other systemic options
- Pathogenic hypotheses for vitiligo.
- Surgical repigmentation
- Segmental vitiligo before and after epidermal transplant surgery
- Combination therapy, maintenance and other options
Hereditary Hypomelanosis
Inherited conditions that reduce or remove pigment from birth, from albinism to piebaldism.
- Oculocutaneous albinism: overview
- Eight genetic types of OCA
- OCA1: the 'tyrosinase-negative' and 'positive' forms
- Type I oculocutaneous albinism in a newborn
- OCA2, OCA3 and OCA4
- OCA2 with sun-related skin cancer and lentigines
- OCA2 with hypopigmented hair and large lentigines
- OCA2 with severe sun damage in dark skin
- Ocular albinism and diagnosis
- Differential diagnosis of diffuse pigmentary dilution
- Managing OCA
- Piebaldism
- Piebaldism: white forelock and forehead patch
- Piebaldism of the mid extremities
- Piebaldism: forelock, extremity and calf patterns
- Piebaldism of the upper calf
- Recognising piebaldism
- Differential diagnosis of circumscribed scalp poliosis.
- Differential diagnosis of circumscribed scalp poliosis. (continued)
- Waardenburg syndrome
- Disorders of melanocyte development.
- Disorders of melanocyte development. (continued)
- The four Waardenburg subtypes
- Waardenburg syndrome type 2 with heterochromia
- Disorders of melanosome biogenesis
- Hermansky-Pudlak syndrome
- Chediak-Higashi and related syndromes
- Griscelli syndrome: melanosome transport
- Tuberous sclerosis complex
- Hypomelanotic macules of tuberous sclerosis complex
- Pigmentary mosaicism
- Blaschko-linear hypopigmentation of the leg
- S-shaped Blaschko-linear hypopigmentation of the trunk
- Segmental pigmentation disorder and nevus depigmentosus
- Nevus depigmentosus
- Diagnosing linear leukoderma
- Differential diagnosis of linear leukoderma
- Disorders with linear hypopigmentation.
- Disorders with linear hypopigmentation. (continued)
Nutritional Hypomelanosis
Diet-related deficiencies that can lighten skin and hair colour.
- Diet and skin colour
Hypomelanosis from Cutaneous Inflammation
How skin disease and its healing process can leave behind pale patches.
- Postinflammatory hypopigmentation: overview
- Postinflammatory hypopigmentation across many causes
- Postinflammatory hypopigmentation in a child with atopic dermatitis
- Lichen striatus along the lines of Blaschko
- Pityriasis alba
- Sarcoidosis
- Hypopigmented variant of cutaneous sarcoidosis
- Hypopigmented mycosis fungoides
- Hypopigmented mycosis fungoides in an adolescent and a child
- Hypopigmented mycosis fungoides in darkly pigmented skin
- Systemic sclerosis and lichen sclerosus
- Leukoderma of systemic sclerosis
- Guttate lichen sclerosus of the areola
- Lichen sclerosus mistaken for vitiligo
- Guttate lichen sclerosus with wrinkling
- Lupus erythematosus
Infectious and Parasitic Hypomelanosis
Skin infections and infestations that leave pale patches behind.
- Tinea versicolor
- Tinea versicolor with scale
- Leprosy (Hansen disease)
- Tuberculoid leprosy
- Treponemal infections
- Onchocerciasis and other parasitic causes
- Onchocerciasis ('leopard skin')
Halo Nevus and Melanoma-Associated Leukoderma
When the immune system attacks pigment cells around a mole or a cancer.
- Halo nevus
- Four stages of a halo nevus
- Melanoma-associated leukoderma
- Pathomechanism of melanoma-associated leukoderma
- Vitiligo-like leukoderma from anti-CTLA-4 therapy
- Perianal dermatitis and leukoderma from ipilimumab
- Leukoderma from combined checkpoint-inhibitor therapy
Chemical and Pharmacologic Hypomelanosis
Industrial chemicals and medicines that can lighten skin, deliberately or as a side effect.
- How chemicals cause leukoderma
- Selected chemicals associated with leukoderma.
- Selected chemicals associated with leukoderma. (continued)
- Selected chemicals associated with leukoderma. (continued)
- Selected chemicals associated with leukoderma. (continued)
- Corticosteroid-induced hypomelanosis
- Hypopigmentation from a steroid injection into the snuff box
- Stellate hypopigmentation after a snuff-box steroid injection
- Hypopigmentation after a knee-joint steroid injection
- Serpentine hypopigmentation from a distal steroid injection
- Drug-induced and other chemical leukoderma
- Chemical leukoderma from rubber swimming goggles
Hypomelanosis from Physical Agents
Burns, cold, radiation and trauma can each leave the skin paler.
- Physical causes of pigment loss
Miscellaneous Hypomelanoses
Common age-related patches, and pale skin that isn't about pigment at all.
- Idiopathic guttate hypomelanosis
- Idiopathic guttate hypomelanosis of the shin
- Look-alikes of guttate leukoderma
- Guttate leukoderma: three look-alike causes
- Differential diagnosis of guttate leukoderma.
- Differential diagnosis of guttate leukoderma. (continued)
- Vagabond's leukomelanoderma and progressive macular hypomelanosis
- Progressive macular hypomelanosis of the back
- Progressive macular hypomelanosis with large circular lesions
- Hair hypomelanosis
- Disorders associated with premature graying of scalp hair.
- Disorders associated with diffuse hypomelanosis of scalp hair.
- Leukodermas without true pigment loss
- Key takeaways
- 0.5%-1%
References
Sources cited in this chapter.
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- Dermatology, 5th Edition (2-Volume Set)