Evaluation of Ocular Findings in Vitiligo

Vitiligo is a pigmentary disorder of the skin and mucous membranes with worldwide incidence of 0.5-2%. The aim of this cross sectional study was to assess the ocular involvement in vitiligo patients. Two hundred patients clinically diagnosed vitiligo attending vitiligo clinic, dermatology department, Jomhorya hospital, Benghazi-Libya over a period of 6 months enrolled in this cross-sectional study. All patients were exposed to detailed disease history and thorough dermatological examination. Out of the total cases, 100 patients had a standard Ophthalmologic examination in cooperation with an ophthalmologist in Benghazi eye hospital. Results of our study showed a slightly higher prevalence of vitiligo in females (male: female ratio 1:2.8). The mean age of onset for males was 22.4 years and for females 24.8 years and 58.5% of patients develop vitiligo below 20 years of age. Generalized vitiligo was the commonest clinical type of vitiligo (57.5%). The relationship between the duration of the disease and its type was statistically significant (P<0.05), there was also a significant relationship between the type of vitiligo and its severity (P< 0.01). Sixteen patients (8%) had segmental vitiligo and the face was the common site involved. The lower limbs were the most commonly affected sites of the body (57%). Ocular changes were seen in 40% of patients and specific ocular abnormalities like uveitis, iritis, and iris and retinal pigmentary abnormalities are present in 15% of patients, nonspecific ocular abnormalities were present in 33% of patients. There was no statistically significant correlation between specific ocular abnormalities, severity and duration of vitiligo.

Analysis of factors associated with skin lesion distribution in 1 125 patients with non-segmental vitiligo / 中华皮肤科杂志

Objective To analyze correlations of the distribution of non-segmental vitiligo lesions with gender,age of onset,duration of disease,personal and family history of autoimmune diseases,family history of vitiligo,and so on.Methods Clinical data were collected from 1 125 patients with confirmed nonsegmental vitiligo in Department of Dermatology,Beijing Hospital from January 2009 to January 2019,and analyzed retrospectively.Statistical analysis was carried out with SPSS 20.0 software by using independentsample t test and chi-square test.Results Of the 1 125 patients with non-segmental vitiligo,599 were males and 526 were females,with a male-to-female ratio of 1.14:1.Their age of onset was 27.9 ± 17.1 years,and duration of disease was 5.2 ± 8.0 years.Skin lesions mostly occurred on the trunk (544 cases,48.4％) and face (535 cases,47.6％),followed by acral regions (430 cases,38.2％),extremities (297 cases,26.4％) and neck (231 cases,20.5％).The perioral region (17.2％),hands (47.9％) and genital region (14.5％) in the 599 male patients were more frequently affected than those in the 526 females (9.7％,22.6％,6.3％,x2 =13.33,77.66,20.01,respectively,all P ＜ 0.001),while the neck (27.0％) was more frequently affected in the female patients than in the male patients (14.9％,x2 =25.29,P ＜ 0.001).The age of onset was significantly lower in the patients with vitiligo lesions involving the legs,knees,feet,trunk,genital and periocular regions than in those without skin lesions on the above corresponding body sites (all P ＜ 0.05),but significantly higher in the patients with vitiligo lesions involving the arms and hands than in those without lesions on the above 2 sites (both P ＜ 0.05).Vitiligo lesions more likely occurred on the hands of patients with a personal or family history of autoimmune thyroid diseases compared with those without the personal or family history (50.0％ vs.27.9％,x2 =6.62,P =0.010).The trunk was more frequently affected in the patients with a family history of vitiligo than in those without (59.6％ vs.45.7％,x2 =13.36,P ＜ 0.001).Conclusion The distribution of non-segmental vitiligo lesions are correlated to some extent with gender,age of onset,personal and family history of autoimmune diseases and family history of vitiligo.

A case of adult Filipino male presenting with co-localized Psoriasis and segmental Vitiligo

@#A 29-year-old male presented with a four-year history of recurrent generalized pruritic erythematous scaly annular plaques followed by a solitary depigmented patch on the right hemiabdomen extending to the back with abrupt midline demarcation. Skin biopsies confirmed the rare case of co-existing and colocalized psoriasis and segmental vitiligo. Treatment with topical steroids, tacrolimus, and narrowband ultraviolet B phototherapy resulted to the improvement of the psoriatic lesions but no change in the depigmented patch.

A descriptive study to characterize segmental vitiligo.

Background: Segmental vitiligo is a small but unique subset of vitiligo requiring due importance due to its lack of response to medical treatment but excellent response to surgical treatment. Characterization of the pattern of segmental vitiligo will also help to understand the pathogenesis of the disease. Aim: To characterize clinically the features of segmental vitiligo, a cross-sectional clinical study at dermatology outpatient department at AIIMS was carried out. Methods: Consecutive 188 patients were evaluated to characterize the clinical features of segmental vitiligo by detailed history, clinical examination, and photography. Frequency of each clinical feature was calculated. Results: Certain features such as early onset, initial progression of disease followed by stability, blaschkoid pattern, irregular margins, leucotrichia within and beyond the vitiligo lesion, and islands of pigmented macules within the vitiligo lesion were found to be characteristic of the disease. Conclusions: A combination of various features such as early onset of disease, blaschkoid pattern, irregular margins, leucotrichia, and islands of pigmented macules within the vitiligo lesion are helpful in diagnosis of the disease.

Segmental vitiligo: A randomized controlled trial to evaluate efficacy and safety of 0.1% tacrolimus ointment vs 0.05% fluticasone propionate cream.

Background: Segmental vitiligo is a small subset of vitiligo which responds very well to surgical therapy, but the role of medical treatment is not very well defined. Aim: To compare the efficacy and safety of 0.1% tacrolimus ointment versus 0.05% fluticasone propionate cream in patients of segmental vitiligo. Methods: A randomized control trial was conducted in a tertiary care hospital on 60 consecutive patients with segmental vitiligo. Patients with segmental vitiligo exclusively or along with focal vitiligo, untreated or had not taken any topical treatment in previous 1 month or systemic treatment in previous 2 months, from May 2005 to January 2007, were block randomized into two groups. Children <5 years, pregnant and lactating women, and patients with known hypersensitivity to either drug and with associated multiple lesions of vitiligo were excluded. Group A (n = 29) patients were treated with tacrolimus 0.1% ointment twice daily and group B (n = 31) patients were treated with 0.05% of fluticasone cream once daily for 6 months. Response and side effects were recorded clinically and by photographic comparison. Results: Nineteen patients treated with tacrolimus and 21 patients treated with fluticasone completed the treatment with median repigmentation of 15% and 5%, respectively, at 6 months (P = 0.38). Transient side effects limited to the application site were observed. Conclusions: Both tacrolimus and fluticasone propionate produce variable but overall unsatisfactory repigmentation in segmental vitiligo.

Childhood vitiligo.

Childhood vitiligo is often encountered in dermatological practice. When present in infancy or early childhood, various nevoid and hereditary disorders are to be differentiated. In many cases, familial aggregation of the disease is seen and other autoimmune disorders may be associated. Segmental presentation is more common, and limited body surface area involvement is usual in this age group. Children with vitiligo often suffer from anxiety and depression because of their unusual appearance. Management of vitiligo in children is difficult as therapeutic options are restricted when compared to that in adult patients. Selection of treatment should be careful in these patients with the aim to achieve best results with minimal side effects as well as relieving patients' and parents' anxiety.

Autologous grafting with epidermal cells suspension to treat patients of segmental vitiligo / 中华医学美学美容杂志

Objective To obtain a simple method to treat segmental vitiligo. Methods The grafting was carried out as following: the epidermal cellular suspension was obtained from leg skin by razor blade after trypsinization. The suspension of epidermal cells were injected into depigmented lesion blisters which were produced by freezing with nitrogen. Results All of the patients which received treatment had successful repigmentation. Conclusion This technique is an effective and simple method for treating patients with segmental vitiligo.

Comparative Clinical Study of Segmental Vitiligo and Non-Segmental Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo was divided into two types, segmental and non-segmental vitiligo. OBJECTIVE: The purpose of our study is to investigate the clinical differences of segmental and non-segmental vitiligo. METHODS: A cross-sectional study, using standard questionnaire items on 1190 cases of vitiligo was performed. RESULTS: The results were summarized as follows 1. The non-segmental vitiligo was 2.4fold more common than segmental vitiligo. 2. The mean age of onset was older in non-segmental vitiligo than in segmental vitiligo. 3. The mean duration was longer in non-segmental vitiligo. 4. The depigmented area was larger in non-segmental vitiligo. 5. The incidences of Koebner phenomenon, progressiveness and mucosal involvement were more common in non-segmental vitiligo. 6. There were no differences about sex ratio, blood typing, family history, and associated disorders. CONCLUSION: Segmental and non-segmental vitiligo differ substantially in various clinical manifestations, which suggests that two types of vitiligo have different pathogenic mechanism.

Bilateral Segmental Vitiligo

Segmental vitiligo is considered to be characterized by unilateral depigmented patches along dermatomes, but we found two cases of segmental vitiligo in which the vitiligo lesions appeared bilaterally on the same or different dermatomes. The clinical course of bilateral segmental vitiligo seems to be the same as that of unilateral segmental vitiligo.

Clinical study of segmental vitiligo / 대한피부과학회지

This is an analysia of 126 cases(14.1%) of segmental vitiligo among 892 vitiligo patient who had visited vitiligo special clinie in Severance Hospital. The results are summarized as follow : 1. There were 53 males(42.1%) and 73 females(57.9%). 2. The mean age of onset was 15.4 years, the mean age on the first visit was 19.3 years, and mean duration of the disease was 4.8 years. 3. Mode of onset was single in 86.5% and the disease was table in 57.1% of patients at the visit. 4. The mean percentage of depigmented lesions was 3.3% and less than 5% of body surface area was involved in 86.5% of patients. 5. The most common site of involvement was head and necl(59.6%), especially face(43.7%) and the trigerminal dermatome was most commonly involved. 6. Poliosis was observed in 39.7%. 7. Family history of vitiligo was obtained in 11.1% of patients. There was no precipitating factors in 126 cases prior to development of vitiligo. 8. Koebner phenomenon was found in 4% of patients. 9. Association with diseases of a proven or suggested allergic or immunologic etiology including atopic dermatitis, halo nevus, uveitis, thyroid disease, lopecia areata and premature graying of hair was found in 10.3% of patients.

The effects of autograft using suction blistered epidermis in the treatment ofvitiligo: the follow-up study of 22 patients / 대한피부과학회지

Autograft using suction hlistered epidermis is one of the surgical therapeutic mod- alities of vitiligo, and has been successfully used by several authors. The maintenance of grafting pigment is belieued to be more important than repigmentation itself. To examine the maintenance of pigment, 22 vitiligo patients were treated by autograft using suction blistered epidermis and followed for 16.8 months. Repigmentation developed in 20 patients, Two patients were lost to follow up. Out of 20 patients, grafting pigment was maintained in 17 patients(85% ) and disappeared in three patients(15% ). By clinical subtype, the rates of maintenance were 100% in segmental type, 80% in localized type and 66% in generalized type. The best results were observed in a head and neck location and the worst rates and maintenance were in the hand. However, these differences were not statistically significant. likewise, age and sex were not factors in maintenance and repigrnentation. Based on this study, autograft using suction blistered epidermis appears to be a good therapeutic modality for stable vitiligo, particularly segmental vitiligo.