Vitiligo is a topic covered in the 5-Minute Clinical Consult.
Segmental: Lesions occur within a dermatome (mostly trigeminal) or may follow Blaschko lines. Lesions usually stop abruptly at the midline.
Generalized/nonsegmental (most common variant): progressive, with flares, commonly associated with autoimmunity. Common locations are acral, periorificial, and in sites sensitive to pressure/friction (Koebner phenomenon).
Universal: involves >80% of the body surface area (BSA). Most likely to have family history; comorbidities are common and associated with poorest quality-of-life (QOL) scores.
Trichrome: Tan zone is present between normal and depigmented skin.
Blue: Dermal melanophages give blue hue, in areas affected by prior postinflammatory hyperpigmentation.
Predominance: male = female; however, females are more likely to seek treatment.
Most likely a spectrum of disorders with a common phenotype and multiple mechanisms contribute to the pathology (convergence theory).
20% of patients report affected relative, but monozygotic twins have only 23% concordance.
HLA haplotypes, small nucleotide polymorphisms, and specific genes are all possible contributors.
Age >50 years at onset should prompt investigation for associated conditions.
Associated with Hashimoto thyroiditis in a significant portion of children. Screening at onset and possibly annually may be beneficial.
Stephens, Mark B., et al., editors. "Vitiligo." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116646/all/Vitiligo.
Vitiligo. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116646/all/Vitiligo. Accessed April 25, 2019.
Vitiligo [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116646/all/Vitiligo.