Skin melanocytic tumor
Other pigmented lesions and disorders of pigmentation
Vitiligo


Topic Completed: 1 April 2013

Revised: 5 April 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Vitiligo

Christopher S. Hale, M.D.
Page views in 2018: 609
Page views in 2019 to date: 673
Cite this page: Hale C Vitiligo. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/skintumormelanocyticvitiligo.html. Accessed October 19th, 2019.
Definition / general
  • Partial or complete loss of pigment producing melanocytes within epidermis (Wikipedia, eMedicine)
  • Patterns:
    • Focal (only a few areas)
    • Segmented (one side of body only)
    • Generalized (most common, both sides of body)
    • Trichrome (patient has three shades of skin color)
Epidemiology
  • Affects 1% of world's population; more noticeable in dark skinned individuals
  • Usually hands / wrists, axilla, perioral, periorbital or anogenital skin
Clinical features
  • Asymptomatic, flat and well demarcated zones of pigment loss, due to an autoimmune disorder associated with pernicious anemia, Addison disease and Hashimoto thyroiditis
  • Perilesional skin up to 5 cm from vitiligo spot is still lighter than normal (Photodermatol Photoimmunol Photomed 2008;24:314)
  • Associated with polymorphisms in COX2 gene (J Dermatol Sci 2009;53:176), mutations of autoimmune regulator gene (Br J Dermatol 2008;159:591)
  • May cause severe psychological distress
  • May worsen with local trauma (cuts, scrapes, burns, Koebner phenomenon)
  • Decreased risk for melanoma and nonmelanoma skin cancer (Br J Dermatol 2013;168:162)
Treatment
Clinical images

Images hosted on other servers:

Various images

Marginal inflammatory

Segmental


Nonsegmental

Hands

Autologous epidermal graft using suction blister

Microscopic (histologic) description
  • Difficult to diagnose by micro alone
  • Decreased melanocytes (use S100 or MelanA and control biopsy from adjacent normal skin, Am J Dermatopathol 2008;30:112)
Electron microscopy description
Differential diagnosis
  • Leukoderma: chemical, melanoma related, scleroderma related; acquired condition with localized loss of skin pigmentation associated with inflammatory skin conditions, burns, intralesional steroid injections, postdermabrasion (Wikipedia)
  • Oculocutaneous albinism: melanocytes present, but no melanin due to defect in tyrosinase enzyme or melanogenesis
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