Medical history (history of illness) represents an important component in the diagnosis of vitiligo (white spot disease). Family history Are there any diseases in your family that are common? Social history Is there any evidence of psychosocial stress or strain due to your family situation? Current medical history/systemic history (somatic and psychological complaints). Have you … White Spot Disease (Vitiligo): Medical History
Blood, hematopoietic organs – immune system (D50-D90). Sarcoidosis of the skin – sarcoidosis is a granulomatous inflammation; the disease is considered an inflammatory multisystem disorder Skin and subcutaneous (L00-L99). Hypomelanosis guttata idiopathica (synonym: idiopathic hypomelanosis) – hypopigmentation likely caused by chronic UV exposure. Nevus depigmentosus – congenital de- or hypopigmentation (leukoderm); etiology (cause): decreased number … White Spot Disease (Vitiligo): Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by vitiligo (white spot disease): Skin and subcutaneous (L00-L99). Infestation of the entire skin Neoplasms – tumor diseases (C00-D48) Malignant (malignant) skin tumors, unspecified. Prognostic factors Large-area depigmentation (> 20%) Confetti-like depigmentation Mucosal involvement Leukotrichia (whitening of the hair) Positive Köbner … White Spot Disease (Vitiligo): Complications
Classification of vitiligo and characteristics of vitiligo subtypes [guidelines: 1]. Vitiligo types Subtypes Comments Non-segmental vitiligo (NSV) Often diffuse with symmetrical, acral to a generalized pattern of distribution (acrofacial vitiligo); localizations: Symmetrically on extensor sides of elbows, forearms, and hands, as well as knees, lower legs, and dorsum of feet; flexor sides of wrists; axillae; … White Spot Disease (Vitiligo): Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing) of the skin, mucous membranes, and sclerae (white part of the eye). Health check
2nd order laboratory parameters TSH (thyroid-stimulating hormone). Thyrotropin receptor autoantibodies (TRAK, also TSH receptor autoantibodies, TSHR-AK) [Graves’ disease]. TPO-Ak (TPO antibodies) [chronic autoimmune thyroiditis (Hashimoto’s thyroiditis): detectable in 90% of cases; active Graves’ disease: detectable in 70% of cases] Total antioxidant capacity Vitamin C 25-OH vitamin D Folic acid Glutathione Selenium Superoxide dismutase Punch biopsy … White Spot Disease (Vitiligo): Test and Diagnosis
Therapeutic target Improvement of the symptoms Therapy recommendations (modified according to) Use of externals (drugs for external application): Glucocorticoids (topical glucocorticosteroids (TCS); topical steroids; preferably mometasone furoate and methylprednisolone aceponate) [guidelines: 1]) in combination with UV-B phototherapy* . No differences in efficacy were found between clobetasol (derivative of betamethasone) and tacrolimus. Calcipotriol (vitamin D analogue) … White Spot Disease (Vitiligo): Drug Therapy
Obligatory medical device diagnostics. Inspection of skin under Wood light – Wood light (Wood lamp) is used in dermatology to examine fluorescent disease foci and pigmentary changes on the skin. The light of the Wood lamp is in the range of long-wave UV-A light (340-360 nm). Dermatoses (skin diseases) that produce a special fluorescent effect … White Spot Disease (Vitiligo): Diagnostic Tests
2nd order Autologous melanocyte-keratinocyte transplantation (donor and recipient are the same) – indication: disfiguring spots on the face. Autologous transplantation of epidermal (ECS) as well as follicular cell suspensions (FCS). For transplantation, ultra-thin tissue from the gluteal region (buttock region) is usually taken for repimentation. Further notes Autologous transplantation of epidermal (ECS) as well as … White Spot Disease (Vitiligo): Surgical Therapy
Prevention of vitiligo (white spot disease) is not possible. Behavioral factors that may trigger vitiligo: Stress Mechanical stimuli, injuries
The following symptoms and complaints may indicate vitiligo (white spot disease): Leading symptoms White patches, especially on the face, neck, hands, and anogenital region. Mostly irregularly shaped spots with hyperpigmented margins. Stains can also confluent (flow together)
Pathogenesis (development of disease) Vitiligo is characterized by an insidious pigment deficiency, usually beginning in adolescence, that results in sharply demarcated white patches of the skin, especially on the face, neck, hands, and anogenital area. The etiopathogenesis of vitiligo is considered multifactorial. The disease is considered to be a T-cell mediated autoimmune disorder. Vitiligo is … White Spot Disease (Vitiligo): Causes
