Image Based Question-66740

Correct Answer » D Explanation

Ans:D. Vitiligo.

The patient is suffering from Non-segmental Vitiligo of hands.

Vitiligo

• 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.

Clinical variants

• 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:

Localized

• 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

Generalized

• Acrofacial: Depigmentation occurs on the distal fingers and periorificial areas

• Vulgaris: Characterized by scattered patches that are widely distributed

• Mixed:

Universal:

• 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.

Management

• 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

Surgery

• The basic types of repigmentation surgery are as follow :

• Noncultured epidermal suspensions

• Thin dermoepidermal grafts

• Cultured epidermis with melanocytes or cultured melanocyte suspensions.