CASE REPORT

Guideline For The Diagnosis and Management of Vitiligo

Adviser :

dr. Suswardana, Sp.KK

Created by :

Lira Fitrianti

121. 0221.078Departement of Dermatovenereology

RSAL Mintohardjo

FK UPN (Pembangunan Nasional University)

Periode 2013Case ReportVitiligo

Abstrack

We report a patient with a larger multiple hypopigmented macules of the face and also on the same side of the neck. We are reporting this case for its often happened and interfere cosmetics.

Key words

hypopigmented, nonsegmental vitiligo, cosmetics.Introduction

Vitiligo is the common depigmenting disorder, with a prevalence a approximately 0.5% in the world population. Almost half of patiens with vitiligo present before 20 years of age. The two sexes are equally affected, and there are not apparent differences in rates of occurrence according to skin type or race. 1Nonsegmental (or genelized) vitiligo and segmental vitiligo have distinctive clinical features and natural histories (table 1). Nonsegmental vitiligo is the most common from the disease (accounting for 85-90% of cases averall). Nonsegmental vitiligo is characterized by onset is more common, progressive, and frequently relapses in situ.1

Case ReportA 41-year-old woman had hypopigmented skin lesions present since 2 years ago on the frontal of her face been treated and cured. Now about 2 weeks ago relaps and progressive depigmented skin lesions almost all faces and anterior of her neck.There isnt family disease such as thyroid disease, particularly autoimmune thyroid disease, type 1 diabetes mellitus and pernicious anemia.

On examination, the face had homogeneous multiple hypopigmented macules varying in size from 0.5 to 2cm, not itchy, have well-defined borders. These macules were present on a background of normal skin. There were depigmented macules of varying sizes with repigmenting margins on the neck (Figure 1).

Figure 1. multiple hypopigmented macules on the face and neck.

The patient was started with protopic 0.1%, elocon, Asthin F, and afamed. For the present patient use foundation and make up to camouflage her vitiligo.Discussion

In this case it was found homogeneous multiple hypopigmented macules varying in size from 0.5 to 2cm, not itchy, have well-defined borders. These macules were present on a background of normal skin. There were depigmented macules of varying sizes with repigmenting margins on the neck. This is consistent with the literatures in nonsegmental vitiligo, typical macules show homogeneous depigmentation and have well-defined borders.1Diagnosis for this patient is nonsegmental vitiligo because it is an acquired chronic depigmentation disorder characterized by white patches. These are often symmetrical and usually increase in size with time.For diagnosis woods lamp may be of benefit in the diagnosis of vitiligo. It has been used to identifyareas of depigmentation that may not be visible to the naked eye, especially in pale skin.3In anamnesa, we should ask previous disease because vitiligo patients show a strong epidemiological association with several other autoimmune diseases, type 1 diabetes mellitus and pernicious anemia.2A clinical diagnosis of nonsegmental vitilgo was made based on onset is more common, progressive, and frequently relapses in situ.1In this case, the patient was started with protopic 0.1%, elocon, Asthin F, and afamed. For the present patient use foundation and make up to camouflage her vitiligo. This is consistent with the literatures that in many instances, the first-line therapy involves topical medicaments. And in most cases, patients are offered advice about use of sunscreens and cosmetic camouflage including fake tanning products.3

Figure 2 : Proposed algorithm for the treatment of vitiligo in japan.2References1. Taieb A.Picardo M. Vitiligo. N Engl J Med. 2009;360:160-9.

2. Oison, Suzuki T, Kaneda M.W, Tanemura A, Tanioka M, Fujimoto T, et al. Guidelines for the diagnosis and treatment of vitiligo in Japan. Journal of Dermatol. 2013; 40: 344354.

3. Gawkrodger D.J, Omerod. A.D, Shaw.L, Sole M.I, Whitton.M. E, Watts.M.J. et al. Guideline For The diagnosis and managment of vitiligo. BJD .2008;159:1051-1076.