Vitiligo

8,221views

00:00 / 00:00

Videos

Notes

Vitiligo

Integumentary system

Pigmented skin disorders

Vitiligo

Albinism

Acneiform skin disorders

Acne vulgaris

Folliculitis

Rosacea

Hidradenitis suppurativa

Papulosquamous and inflammatory skin disorders

Contact dermatitis

Atopic dermatitis

Lichen planus

Pityriasis rosea

Psoriasis

Seborrhoeic dermatitis

Urticaria

Keratotic skin disorders

Actinic keratosis

Vesiculobullous skin disorders

Epidermolysis bullosa

Bullous pemphigoid

Pemphigus vulgaris

Desquamating skin disorders

Erythema multiforme

Stevens-Johnson syndrome

Skin integrity disorders

Pressure ulcer

Sunburn

Burns

Frostbite

Skin infections

Cellulitis

Erysipelas

Impetigo

Necrotizing fasciitis

Human papillomavirus

Varicella zoster virus

Poxvirus (Smallpox and Molluscum contagiosum)

Coxsackievirus

Herpes simplex virus

Candida

Malassezia (Tinea versicolor and Seborrhoeic dermatitis)

Pediculus humanus and Phthirus pubis (Lice)

Sarcoptes scabiei (Scabies)

Human herpesvirus 6 (Roseola)

Parvovirus B19

Varicella zoster virus

Measles virus

Rubella virus

Skin neoplasms

Vascular tumors

Human herpesvirus 8 (Kaposi sarcoma)

Angiosarcomas

Skin cancer

Hair and nail disorders

Alopecia areata

Telogen effluvium

Onychomycosis

Integumentary system pathology review

Pigmentation skin disorders: Pathology review

Acneiform skin disorders: Pathology review

Papulosquamous and inflammatory skin disorders: Pathology review

Vesiculobullous and desquamating skin disorders: Pathology review

Skin cancer: Pathology review

Bacterial and viral skin infections: Pathology review

Viral exanthems of childhood: Pathology review

Assessments

Vitiligo

Flashcards

0 / 6 complete

USMLE® Step 1 questions

0 / 1 complete

High Yield Notes

5 pages

Flashcards

Vitiligo

of complete

Questions

USMLE® Step 1 style questions USMLE

of complete

A 37-year-old woman comes to her primary care provider for evaluation of skin patches that are lighter in color than the surrounding skin. Her symptoms began 4-months ago and have progressively worsened. The affected areas are non-painful and non-pruritic. Past medical history is notable for type II diabetes mellitus and hypothyroidism, for which she is currently taking metformin and levothyroxine, respectively. Temperature is 37.8°C (100.0°F), blood pressure is 116/73 mmHg, and pulse is 65/min. Physical examination of the patient’s skin reveals the following:

Reproduced from: Wikimedia Commons

Cardiac, pulmonary, and abdominal examinations are noncontributory. Which of the following best describes the pathophysiology of this patient’s condition? 

External References

First Aid

2022

2021

2020

2019

2018

2017

2016

Melanocytes

in vitiligo p. 488

Vitiligo p. 488

Transcript

Content Reviewers

Rishi Desai, MD, MPH

Contributors

Evan Debevec-McKenney

Vitiligo, likely meaning blemish, is a non-contagious skin condition that is defined by patches of discoloration, or depigmentation.

Though vitiligo can affect any race or ethnicity, it tends to be most noticeable in people with darker skin, like Canadian fashion model Winnie Harlow.

Given the effect on a person’s appearance, pigment loss can really impact a person’s quality of life.

The skin is divided into three layers--the epidermis, dermis, and hypodermis.

The hypodermis is made of fat and connective tissue that anchors the skin to the underlying muscle.

Just above is the dermis, which contains hair follicles, nerves and blood vessels.

And just above, the outermost layer of skin, is the epidermis.

The epidermis itself has multiple cell layers that are mostly keratinocytes - which are named for the keratin protein that they’re filled with.

Keratin is a strong, fibrous protein that allows keratinocytes to protect themselves from getting destroyed when you rub your hands through the sand at the beach.

Keratinocytes start their life at the deepest layer of the epidermis called the stratum basale, or basal layer, which is made of a single layer of small, cuboidal to low columnar stem cells that continually divide and produce new keratinocytes that continue to mature as they migrate up through the epidermal layers.

But the stratum basale also contains another group of cells - melanocytes, which secrete a protein pigment, or coloring substance, called melanin.

Melanin is actually a broad term that constitutes several types of melanin found in people of differing skin color.

These subtypes of melanin range in color from black to reddish yellow and their relative quantity and rate at which they are metabolized define a person’s skin color.

When keratinocytes are exposed to the sun, they send a chemical signal to the melanocytes, which stimulates the melanocytes into making more melanin.

The melanocytes move the melanin into small sacs called melanosomes, and these get taken up by newly formed keratinocytes, which will later metabolize the melanin as they migrate into higher layers of the epidermis.

Melanin then acts as a natural sunscreen, because its protein structure dissipates, or scatters, UVB light--which if left unchecked can damage the DNA in the skin cells and lead to skin cancer.

Summary

Vitiligo is a skin condition characterized by patches of depigmentation that can affect any race or ethnicity, but is most noticeable in people with darker skin. Melanocytes, which secrete the pigment melanin, are responsible for skin color, and their loss or dysfunction causes vitiligo. The exact cause of melanocyte destruction is unknown, but genetics and environmental triggers may play a role. The main symptom is irregularly shaped patches of depigmentation, which can be small or large and may expand over time. Treatment includes cosmetic cover-up, topical and systemic immune suppressants, UV phototherapy, skin bleaching, and skin grafts. Sunscreen is also recommended to reduce the risk of skin cancer.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Vitiligo" The Lancet (2015)
  6. "Evidence-based management of vitiligo: summary of a Cochrane systematic review" British Journal of Dermatology (2016)
  7. "Stressful Life Events, Social Support, Attachment Security and Alexithymia in Vitiligo" Psychotherapy and Psychosomatics (2003)
Elsevier

Copyright © 2023 Elsevier, except certain content provided by third parties

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.

RELX