Review Question - QID 103815

This patient has vitiligo, an autoimmune condition resulting in the loss of melanocytes.

Vitiligo is an autoimmune disease in which immune cells attack and destroy melanocytes resulting in characteristic skin lesions (Figure A). Vitiligo is associated with several other autoimmune conditions including Hashimoto thyroiditis, Graves disease, type 1 diabetes mellitus, psoriasis, and rheumatoid arthritis. In addition to the depigmented skin, patients with vitiligo often have an array of psychological disturbances, thought to be a result of the disfiguring nature of the disease.

Plensdorf and Martinez discuss common pigmentation disorders. They note that hypopigmentation disorders are typically benign in nature and that common disease on the differential include vitiligo, tinea versicolor, and postinflammatory inflammation. They note that treatment options for vitiligo include cosmetic coverage, or UV therapy.

Kwon et al. conducted a small clinical trial to examine the efficacy of tretinoin in preventing skin atrophy from topical corticosteroids for 50 patients with vitiligo. They conducted a paired comparison with left-right randomization of patients. The study demonstrated that patients had 55% of patients had a better response (measured as computer system scored visual appearance) to tretinoin plus corticosteroid than just corticosteroid, and this effect was demonstrated within the first 3 months of treatment.

Figure A is an image of a patient with vitiligo.
Illustration A is an example of the lesions caused by tinea versicolor.

Incorrect Answers:
Answer 1: Vitiligo is not caused by a congenital absence of melanocytes.
Answer 2: Inadequate production of melanin is the mechanism underlying albinism, not vitiligo.
Answer 3: While fungal infection may cause hypopigmented lesions (Illustration A), these lesions are often sharply demarcated, and itchy.
Answer 5: Given that the patient is feeling well, and the fact that these lesions are consistent with vitiligo, it is unlikely that these patches are due to an underlying viral infection.