Differential Diagnosis of Vitiligo in Brown Skin

Ma. Teresita G. Gabriel, Gracia B. Teodosio, and Nani Kumala Dewi Tasmin

Introduction

Various conditions have similar clinical presentation with vitiligo. Alikhan et al. classified the different differential diagnosis of vitiligo into occupational iatrogenic chemical leukoderma, genetic syndromes, malformations, idiopathic, infections, neoplastic, and postinflammatory hypopigmentation [1]. Listed in Table 24.1 are the mimickers of vitiligo, as we see it among people with brown skin. Good history taking, a thorough physical examination, and the judicious use of histopathology generally yield a straightforward diagnosis.

Genetic Syndromes

Piebaldism

Piebaldism is an autosomal dominant disorder in tyrosine kinase transmembrane receptor of the melanocyte. This congenital condition is characterized by an extensive, symmetrically distributed depigmented areas. It has been reported in all races with equal sex distribution [2]. Midfrontal poliosis (Fig. 24.1) is seen in 80-90 % of cases. Depigmentation, however, may cover minimal to extensive areas of the entire body. Histopathology reveals a decreased number or total absence of melanocytes and melanin.

M.T.G. Gabriel, MD (*) • G.B. Teodosio • N.K.D. Tasmin Department of Dermatology, Research Institute of Tropical Medicine, Alabang, Muntinlupa City, Philippines

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E.B. Handog, M.J. Enriquez-Macarayo (eds.), Melasma and Vitiligo in Brown Skin, DOI 10.1007/978-81-322-3664-1_24

Camouflage or surgical grafting may be helpful and autologous noncultured epidermal cell transplantation has been reported with good result [2, 3].

Table 24.1 Mimickers of vitiligo among people with brown skin

Classification

Disease

Occupational leukoderma

Phenols and other derivatives

Genetic syndromes

Piebaldism

Tuberous sclerosis

Hypomelanosis of Ito

Malformations

Nevus anemicus

Nevus depigmentosus

Idiopathic

Idiopathic guttate hypomelanosis

Lichen sclerosus et atrophicus

Infections

Tinea versicolor

Leprosy

Syphilis

Neoplastic

Mycosis fungoides

Halo nevus

Postinflammatory hypopigmentation

Pityriasis alba

Atopic dermatitis/allergic contact dermatitis

Phototherapy-induced hypopigmentation

Hypopigmented scar

Psoriasis

Discoid lupus erythematosus

Scleroderma

Topical drug-induced depigmentation

Midfrontal poliosis in a Filipina with piebaldism

Fig. 24.1 Midfrontal poliosis in a Filipina with piebaldism

 
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