VITILIGO

MIKAEL SRI PABILANG

AIMI HANIZA ZAINAL

AHMAD FAHIMULLAH BIN HAMZAH

PATIENT IDENTITY

Name : Nursiah Gender : Age : 68 years old Address : Tidung Came to hospital at : January 13th ,

2011

HISTORY TAKING

A woman, 68 years old, came to Wahidin Sudirohusodo’s hospital with circumscribed depigmented macules and patches at both of her hands and on the face since two years ago. No history of allergies. No family history with the same disease. This patien had been diagnosed with vitiligo by the doctor when she come to the hospital at the first time.

DIFFERENTIAL DIAGNOSIS

Vitiligo Piebaldisme Tinea versicolor Pityriasis alba

The presence of stable amelanotic patches since birth, the characteristic distribution pattern, and the

distinctive normally or hyperpigmented macules within the areas of leukoderma allow the differentiation of piebaldism from vitiligo

Piebaldism

Vitiligo

Circumscribed depigmented macules and patches

Scales with fluorescence under Wood's lamp, positive KOH

Tinea versicolor

Pityriasis alba

Slight scaling, fuzzy margins, off-white color, ill-defined border

TREATMENT

The aims of vitiligo treatments are repigmentation and stabilization of the depigmentation process. Although there is still no therapeutic panacea for vitiligo, the many options available may lead to satisfactory results in most patients.

TYPES OF THERAPY :

Narrowband UVB Psoralen plus phototherapy Topical (paint) PUVA PUVASOL (psoralens + natural

sunlight) Corticosteroids

PHYSICAL EXAMINATION

Wood's Lamp Examination Required to evaluate macules, particularly in lighter skin types, and to identify macules, in sun-protected areas in all but the darkest skin types.

LABORATORY EXAMINATION Dermatopathology

In certain difficult cases, a skin biopsy may be required. Established vitiligo macules show normal skin except for an absence of melanocytes.

Electron MicroscopyAbsence of melanocytes and of melanosomes in keratinocytes; also changes in keratinocytes: spongiosis, exocytosis, basilar vacuopathy, and necrosis. Lymphocytes have been seen in the epidermis.

Laboratory StudiesT4, TSH (radioimmunoassay), fasting blood glucose, complete blood count with indices (pernicious anemia), ACTH stimulation test for Addison's disease, if suspected.

PROGNOSIS

Vitiligo is a chronic disease. The course is highly variable, but rapid onset followed by a period of stability or slow progression is most characteristic. Up to 30% of patients may report some spontaneous repigmentation in a few areas—particularly areas that are exposed to the sun. Rarely is this sufficient to satisfy the cosmetic burden that the patient feels. Rapidly progressive or "galloping" vitiligo may quickly lead to extensive depigmentation with a total loss of pigment in skin and hair, but not eyes.

DRUG HISTORY

Inerson cream Interhistin 2x1 Neurodex 1x1 Methylprednison 4 mg 2-1-0 Hydrocortison 10 gr Fuson 15 gr

PRESENT STATUS

General Status : Composmentis Mild sickness Adequate nutrion Good hygiene Vital sign : Blood Pressure : 130/80 mmHg Pulse Rate : 88x/ min Respiration Rate : 17x/ min Temperature : 36,8 celsius

DERMATOVENEROLOGY

Dermatology and Venerology Status : Effloressence : Hypopigmentation

macules and patch Location : Regio Dorsal manus

dextra sinistra and regio fasialis

Skin Diagnose : Vitiligo

PICTURE

RESUME

A woman, 68 years old, came to Wahidin Sudirohusodo’s hospital with circumscribed depigmented macules and patches at both of her hands and on the face since two years ago. No history of allergies. No family history with the same disease. This patien had been diagnosed with vitiligo by the doctor when she come to the hospital at the first time.

Cont...

On Physical Exams found The General Status : Composmentis, Mild

sickness, Adequate nutrition and Good hygiene.

Vital sign : BP : 130/80 mmHg RR : 17x/ min PR : 88x/min T : 36,8 celcius Status Dermatovenerology is found the

effloressence circumscribed depigmented macules and patches at both of her hands and on the face .

The Clinical Diagnose is Vitiligo

DISCUSSION

Vitiligo is a pigmentation disorder in which melanocytes (the cells that make pigment) in the skin are destroyed. As a result, white patches appear on the skin in different parts of the body.

Similar patches also appear on both the mucous membranes (tissues that line the inside of the mouth and nose) and the retina (inner layer of the eyeball).

Cont....

Three principal theories have been presented about the mechanism of destruction of melanocytes in vitiligo: The autoimmune theory holds that selected

melanocytes are destroyed by certain lymphocytes that have somehow been activated.

The neurogenic hypothesis is based on an interaction of the melanocytes and nerve cells.

The self-destruct hypothesis suggests that melanocytes are destroyed by toxic substances formed as part of normal melanin biosynthesis.