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Contempo Updates | Clinician's Corner

New Insights and New Therapies in Vitiligo

Pearl E. Grimes, MD
JAMA. 2005;293(6):730-735. doi:10.1001/jama.293.6.730.
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Quiz Ref IDVitiligo is a relatively common, acquired pigmentary disorder characterized by areas of depigmented skin resulting from loss of epidermal melanocytes. The prevalence of this disease varies from 0.1% to 2% in various global populations. Onset may occur at any age, but the incidence usually peaks in the second and third decades of life. Patterns of distribution of the disease include the generalized, acral or acrofacial, localized, and segmental types. The generalized distribution is the most common pattern and is characterized by symmetrically distributed areas of depigmentation. Segmental vitiligo is the least common pattern and occurs in a dermatomal or quasi-dermatomal distribution, often following the distribution of the trigeminal nerve. The course of the disease is unpredictable. Vitiliginous skin lesions may remain stable or slowly progress for years. In some instances, however, patients undergo rapid, complete depigmentation in 1 or 2 years.

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Figure 1. Photomicrographs of Vitiliginous vs Healthy Skin
Graphic Jump Location

Immunohistochemical staining for melanocytes using an alkaline phosphatase detection kit and a 1:5 dilution of MEL-5 antibody after predigestion for 4 minutes with protease. A, vitiliginous skin; B, healthy skin with scattered cells in the basal layer positive to MEL-5 antibody (red chromogen) (magnification ×20).

Figure 2. Patient With Vitiligo Before and After Treatment With Narrowband UV-B
Graphic Jump Location

A, Patient with more than 20% cutaneous surface depigmentation at baseline. B, The same patient with extensive areas of repigmentation after receiving 47 narrowband UV-B treatments.




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