A 22 Year Old Lady Presents With Skin Depigmentation

A 22 year old lady is seen by a dermatologist for the complains of skin depigmentation and appearance of white patches on her hands, face and arms. She first noticed around 6 months ago as a spot in her face but now the depigmentation is spreading through tout her body gradually. She has also noticed her scalp hair turn white. The white patches are mostly symmetrical in distribution and there is no itching or any signs of infection in the involved areas.
The picture of her hands is shown below:

What is the most probable diagnosis?

Vitiligo.

Case Discussion:
Vitiligo is a skin disease that causes loss of skin color and is characterized by portions of skin depigmentation seen as white patches. The disease is not contagious or life threatening but it leads to severe mental stress and cosmetic issues.
The disease can affect all types of skin but it is more prominent in people with dark skin.
The incidence is equal in both sexes but females may present early and more often because of cosmetic reasons.

Etiology: Vitiligo occurs when the normal pigment producing cells of the skin known as melanocytes die or stop producing melanin ( the substance that gives normal color to the skin). There may be different underlying reasons for the melanocytes to stop functioning and theses may include:

• Autoimmune disorder that kills theses cells.
• Family History
• Exposure to chemical
• Severe burns destroying the tissues.

Underlying Diseases That Should Be Considered In Patients With Vitiligo: 

Sometime vitiligo may be a presentation of some underlying autoimmune or an endocrine disorder and it is important for the doctor to consider these. They include:

• Addision's disease
• Type I Diabetes mellitus
• Hashimoto's thyroidits.
• Graves dieases
• Pernicious anemia
• Atrophic gastritis
• Primary biliary cirrhosis
• Premature ovarian failure.

Management: Diagnosis is usually clinical and when uncertain a skin biopsy can be done 

There is no permanent cure for vitiligo but different options including steroids and treatment with ultravoilet light may sometimes be helpful. Sometimes the disease may never progress while in some cases it may go on to involve the skin throughout the body.  

Differential Diagnosis:

• Addisions disease
• Chemical Leukoderma
• Leprosy
• Postinflammatory depigmintation
• Malignant melanoma
• Mycosis fungoidosis
• Tenia versicolor
• Side effect of certain drugs.