Diagnosing vitiligo is not very difficult, but assessing the risk factors and ruling out other underlying serious diseases can be a challenge for the treating physician or dermatologist. Age at onset , family history, precipitating events, occupational hazards, extent and area of involvement, hair and eye involvement, treatments taken so far and the effects of each have to be assessed before a therapeutic regimen is prescribed for the patient.
I Have Been Diagnosed with Vitiligo. Are There any Laboratory Investigations That I Have to Undergo?
Yes, a few lab tests are done when vitiligo is diagnosed to rule out any other associated diseases. The following are the basic tests required:
- Fasting and post meal blood sugar
- Thyroid Function tests
- Adrenal Function tests
- Liver and renal function tests
- Antinuclear antibody tests
In addition, Wood’s lamp examination will help diagnose vitiligo in fair skinned individuals.
What Other Skin Diseases Have to be Ruled Out in a Case of Vitiligo?
Certain diseases of skin with loss of color may mimic early vitiligo, though fully developed vitiligo is easily diagnosed. Following are some of the main disorders of skin with color loss:
- Pityriasis alba
- Pityriasis versicolor
- Nevus anemicus
- Nevus depigmentosus
- Leprosy
- Post inflammatory hypopigmentation or leukoderma
- Discoid lupus erythematosus
- Mycosis fungoides
- Sarcoidosis
- Tuberous sclerosis
- Psoriasis
- Secondary syphilis
- Scleroderma
- Lichen Scerosis et atrophicus
Are There any Genetic Diseases That Present With White Patches on the Skin Like Vitiligo ?
Yes, there are many genetic or hereditary skin diseases which present with loss of skin color. To name a few,
- Waardenburg’s syndrome, where the child is born with congenital deafness, multicolored iris, white skin patches, white forelock and widening of nasal root.
- Ziprowski-Margolis syndrome, associated with deaf-mutism, heterochromic irides, and white skin patches.
- Woolf’s syndrome, also known as piebaldism, with white forelock, deafness and black patches within areas of depigmented skin.
- Albinism, where there is generalized hypo(decreased)pigmentation or depigmentation of the skin and hair, nystagmus, light intolerance and decreased vision.
In addition, certain disorders of amino acid metabolism like phenylketonuria, histidinemia and homocystinuria also present with skin hypopigmentation as a feature.
How to Differentiate Vitiligo From Leukoderma?
Vitiligo and leucoderma (leukoderma) is used synonymously most of the time, but both are different. Vitiligo is an autoimmune disease of unknown origin, while leukoderma is a collective term applied to the skin condition in which depigmentation occurs following some inflammatory injury to the skin.
In vitiligo though there may be a history of skin injury in some patients, subsequent white patches appear in normal looking skin. The surface of the skin in vitiligo is normal and there is usually a dark margin at the periphery. In post inflammatory leukoderma, the affected patches show an irregular mottling of dark and white blotchy surface. The distribution in vitiligo is usually symmetrical, although sometimes it is unilateral or dermatolomal in distribution. In leukoderma, the depigmentation is present only at the site of injury.
Thus diagnosing vitiligo clinically is easy, but one has to rule out the presence of associated diseases and other diseases causing loss of skin color.
Related Articles
Reference
- J Yohn. Disorders of Pigmentation. In JS Fitzpatrick, JL Aeling, Eds. Dermatology Secrets. Hanley & Belfus. 108-119; Ed 1,1996.
- Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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