Vitiligo

Overview

• Definition: Acquired, chronic depigmenting disorder where pigment-producing cells (melanocytes) are progressively lost
• Appearance: Milky-white patches of skin (leukoderma), cosmetically disabling, especially in people with dark skin
• Prevalence: Affects 0.5–2% of the population

Epidemiology

Race

• Consistent Incidence: Across all races
• Less Common: Han Chinese population
• More Common: India (up to 8.8% of the population)

Sex

• Equal Incidence: In men and women
• Higher Outpatient Visits: Among women due to cosmetic concerns

Onset

• Average Age: 20–24 years, but can occur at any age
• Peaks of Onset:
  • Early (<10 years)
  • Late (around 30 years)
• Age Statistics:
  • 41% of segmental vitiligo cases start before age 10
  • 50% of non-segmental vitiligo cases start before age 20
  • 80% of all cases present before age 30

Inheritance

• Pattern: Polygenic
• Monozygotic Twin Concordance: 23%
• Affected Individuals: 20–30% report vitiligo in a first or second-degree relative

Associated Autoimmune Disorders

• Thyroid Disease: 15% of adults and 5–10% of children with vitiligo
• Rheumatoid Arthritis
• Insulin-Dependent Diabetes Mellitus: Mostly adult-onset
• Pernicious Anaemia (B12 Deficiency)
• Addison Disease
• Systemic Lupus Erythematosus
• Alopecia Areata
• Psoriasis and Lichen Sclerosus

Treatment

• Aim: Stop progression (stabilization) and achieve satisfactory re-pigmentation
• General Measures:
  • Avoid skin injury: Wear protective loose-fitting clothing
  • Cosmetic camouflage: Make-up, dyes, stains, waterproof products, dihydroxyacetone-containing products (“tan without the sun”), micropigmentation or tattooing for stable vitiligo
  • Sun protection: Clothing, sunscreen use, lifestyle modification
  • Note: Depigmented skin can only burn, not tan; sunburn may cause vitiligo to spread; tanning of normal skin makes patches more visible

Specific Measures

• Topical Corticosteroids:
  • Used on the trunk and limbs for up to 3 months
• Calcineurin Inhibitors (Pimecrolimus Cream and Tacrolimus Ointment):
  • Preferred for eyelids, face, neck, armpits, and groin
  • Do not cause skin atrophy
• Topical Vitamin D Derivatives:
  • Calcipotriol, Tacalcitol
• Ruxolitinib Cream: