A woman suffering from an Autoimmune Thyoid disorder presented with skin condition of both the hands as shown in the image.What will be the most probable diagnosis?
C. Pityriasis Alba
The patient is suffering from Non-segmental Vitiligo of hands.
- It is an acquired pigmentary disorder of the skin and mucous membranes that is characterized by circumscribed, depigmented macules and patches.
- The condition is frequently associated with disorders of autoimmune origin, with thyroid abnormalities being the most common.
Vitiligo lesions are characterized as follows:
- White or hypopigmented
- Usually well demarcated
- Round, oval, or linear in shape
- Borders may be convex
- Range from millimeters to centimeters in size
- Enlarge centrifugally over time at an unpredictable rate
- Initial lesions occur most frequently on the hands, forearms, feet, and face, favoring a perioral and periocular distribution.
- Trichrome vitiligo: An intermediate zone of hypochromia is located between the achromic center and the peripheral unaffected skin, resulting in 3 shades of color—brown, tan, and white—in the same patient
- Marginal inflammatory vitiligo: Lesions have a red, raised border, which is present from the onset of vitiligo (in rare cases) or may appear several months or years after the initial onset; mild pruritus may be present
- Quadrichrome vitiligo: Reflects the presence of a fourth color (ie, dark brown) at sites of perifollicular repigmentation
- Blue vitiligo: Results in blue coloration of vitiligo macules
- Koebner phenomenon: Development of vitiligo in sites of specific trauma, such as a cut, burn, or abrasion.
Vitiligo can be classified as follows:
- Focal: Characterized by 1 or more macules in 1 area, most commonly in the distribution of the trigeminal nerve
- Segmental: Manifests as 1 or more macules in a dermatomal or quasidermatomal pattern; occurs most commonly in children; more than half the patients with segmental vitiligo have patches of white hair or poliosis
- Mucosal: Mucous membranes alone are affected
- Acrofacial: Depigmentation occurs on the distal fingers and periorificial areas
- Vulgaris: Characterized by scattered patches that are widely distributed
- Universal vitiligo results in complete or nearly complete depigmentation. It is often associated with multiple endocrinopathy syndrome.
Microscopic examination of involved skin :
- It shows a complete absence of melanocytes in association with a total loss of epidermal pigmentation. Superficial perivascular and perifollicular lymphocytic infiltrates may be observed at the margin of vitiliginous lesions, consistent with a cell-mediated process destroying melanocytes.
- Nonsurgical treatments
- Systemic phototherapy: Induces cosmetically satisfactory repigmentation.
- Laser therapy
- Steroid therapy
- Depigmentation therapy: If vitiligo is widespread and attempts at repigmentation have not produced satisfactory results, depigmentation may be attempted in selected patients
- Micropigmentation: Tattooing can be used to repigment depigmented skin in dark-skinned individuals
- The basic types of repigmentation surgery are as follow :
- Noncultured epidermal suspensions
- Thin dermoepidermal grafts
- Cultured epidermis with melanocytes or cultured melanocyte suspensions.