VITILIGO

Vitiligo is characterized by sharply demarcated, completely white (depigmented) patches. They usually start small and expand. The acral areas and the face are commonly involved. In general, there are two clinical variants of vitiligo. The classic type (aka vitiligo, non-segmental vitiligo) is acquired in late childhood or adulthood and is symmetric. A less common variant is segmental vitiligo which tends to have its onset early in life and is asymmetric (often involving a dermatome).

• Vitiligo may occur at any age, but onset from 10-30 is typical. 50% have onset before age 20.
  
• Any patient over 40 years of age who develops what looks like vitiligo should have a complete skin examination to exclude melanoma.
• In children, halo nevi are often associated.
  
• It seems to represent an autoimmune condition in which the patient's own immune system is attacking the pigment-producing cells (i.e., melanocytes).
  
• It occurs in about 1-2% of the world's population.
• A family history is present about 20-30% of the time and is more common in patients with younger onset of the disease.
  
• There is a high incidence of psychiatric comorbidities, e.g. 28% anxiety disorder, 25% depression among others.
• It has been recommended that thyroid function is checked at baseline and rechecked every 3 years as the incidence increases over time (approximately doubles every 5 years).
• Depigmentation by chemical exposure can present in a similar manner (chemical leukoderma).

Treatment

Adults and Children 12 years of age and older

Opzelura (ruxolitinib 1.5% cream BID) is a new and exciting advance in the treatment of vitiligo. It is FDA-approved for children 12 and older. Recommended treatment is as follows: apply a thin layer of OPZELURA twice daily to affected areas of up to 10% body surface area. Look for good results at 3-6 months but for those that do not fully respond at 6 months, many can get good results if continued for 2 years.

Children under 12 years of age

Topical steroids, topical calcineuron inhibitors (e.g. tacrolimus and pimecrolimus) and narrow band UVB may be used.

Additional Pictures

Segmental Vitiligo. Ruxolitinib is not effective for segmental vitiligo.

RegionalDerm

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