13 - 76 - VITILIGO

Question 1

Clinical signs of lesional activity in vitiligo

Answer 1

confetti, trichrome, and inflammatory lesions, koebnerization

Question 2

this variant of vitiligo tends to occur earlier in life

Answer 2

segmental variant

Question 3

often the initial sites of vitiigo

Answer 3

face, as well as acral and genital locations

Question 4

• eportedly more common in adults and typically involves the hands, feet, and face, particularly the orifices
• may evolve to typical generalized vitiligo

Answer 4

Acrofacial vitiligo

Question 5

• rare form of widespread disease
• usually seen in adults, although cases in children have been reported
• affects a large proportion of the body, frequently defined as greater than 80% of the body surface area

Answer 5

Vitiligo universalis

Classically, vitiligo universalis results from longstanding disease that steadily progresses to nearly complete whitening of the skin.

Question 6

oral and/or genital mucosae are primarily involved

Answer 6

Mucosal vitiligo

Question 7

variant that consists of small, isolated lesions

Answer 7

Focal vitiligo

Question 8

unilateral and segmental, or block-shaped, distribution of the lesions

Answer 8

segmental variant of vitiligo

In segmental vitiligo, there is frequently early involvement of the follicular melanocyte reservoir, resulting in poliosis.

Question 9

rare form of vitiligo that refers to the occurrence of a clear example of segmental vitiligo plus additional macules or patches that do not fit the segment

Answer 9

Mixed vitiligo

These additional patches may be remote from the segmental involvement and are bilateral and symmetrical, affecting the contralateral side.

Question 10

In this variant, there is frequently early involvement of the follicular melanocyte reservoir, resulting in poliosis.

Answer 10

segmental vitiligo

Question 10

describe the course of segmental vitiligo

Answer 10

The disease usually spreads over the segment within 6 to 12 months, and then stabilizes

Question 11

associated with higher body surface area involvement in vitiligo and** poorer response to treatment**

Answer 11

Koebner phenomenon

Question 11

observation that depigmentation occurs readily at the site of skin trauma in patients with active vitiligo

Answer 11

Koebner phenomenon, also called the isomorphic response

This can be recognized as linear marks of depigmentation where the skin has been scratched, lacerated, or burned, or nonlinear macules and patches at the site of known skin injury, such as erosions and abrasions

Question 12

characterized by blurring of lesional borders because of the presence of a hypopigmented zone between the depigmented and normally pigmented border

Answer 12

Trichrome vitiligo

Question 13

This results in the appearance of 3 distinct colors: the depigmented skin, normally pigmented skin, and hypopigmented skin

Answer 13

Trichrome vitiligo

Question 14

This pattern is associated with active, rapidly spreading vitiligo

Answer 14

Trichrome vitiligo

Question 15

consists of multiple small macules of depigmentation clustered together, often at the edge of existing vitiligo lesions

Answer 15

Confetti-like depigmentation

Question 16

this sign as an important marker of disease activity

Answer 16

Confetti-like depigmentation

Question 17

very rare form of vitiligo characterized by the presence of erythema, scale, and itch at the border of hypopigmented or depigmented lesions

Answer 17

Inflammatory vitiligo

typically transient, lasting just a few weeks to months but rapidly progressing to involve large areas of the body

Question 18

6-point scale that was developed with the aim of assessing and monitoring vitiligo activity.

Answer 18

vitiligo disease activity score (VIDA) score

Question 19

defined as the spread of existing lesions or onset of new lesions

Answer 19

Active vitiligo

Question 20

VIDA score where vitiligo is stable for 1 year or more with spontaneous repigmentation

Answer 20

-1

Question 21

• uses the Koebner phenomenon and anatomical location of lesions to determine disease activity in vitiligo patients
• It is based on the presence or absence of vitiligo lesions at 6 different areas of the body (forehead + scalp areas, eyelids, wrists, genital + belt areas, knees and tibial crests) as well as disease duration.
• ranges from** 0 to 56,** with 56 corresponding to the highest likelihood of having the Koebner phenomenon, which serves as an indicator of disease activity in the clinic

Answer 21

K-VSCOR

Question 22

Associated autoimmune diseases with vitiligo

Answer 22

type 1 diabetes, autoimmune thyroiditis, pernicious anemia, Addison disease, lupus, and alopecia areata

Question 22

Up to 20% of vitiligo patients have at least 1 additional autoimmune disease, and most of these patients (13% to 19%) have what disease?

Answer 22

autoimmune thyroid disease ## Footnote * This increased risk has prompted some to advocate testing thyroidstimulating hormone (TSH) in all patients with vitiligo, because the pretest probability of finding a positive result is higher in this patient population. * Others suggest, however, that this is unnecessary, because many patients will develop thyroid disease much earlier or later than the onset of vitiligo, and recommend that the presence of symptoms should drive TSH screening.

Question 23

T/F vitiligo patients have close to 3-fold higher risk of developing melanoma, basal cell carcinoma, and squamous cell carcinoma compared to controls

Answer 23

FALSE Lower risk

Question 24

results in skin depigmentation with prominent poliosis, as well as **hearing loss, visual changes, *meningitis, and flu-like symptoms*

Answer 24

Vogt-Koyanagi-Harada syndrome (VKHS)

Question 25

segmental vitiligo (unilateral depigmentation) on the face with poliosis, plus **ipsilateral hearing loss and visual changes**

Answer 25

Alezzandrini syndrome

Question 26

Vitiligo is an autoimmune disease of the skin in which what type of T cells target melanocytes and destroy them?

Answer 26

CD8+ T cells

Question 27

Additional studies have now revealed that certain chemicals, typically ______, induce the cellular stress response in melanocytes by acting as analogs of tyrosine, also a phenol

Answer 27

phenols ## Footnote Thus, these chemicals act as exogenous environmental agents that induce and exacerbate vitiligo by initiating the cellular stress response in otherwise well-compensating melanocyte

Question 28

play a critical role during the progression of vitiligo, serving as the primary immune effectors that destroy melanocytes

Answer 28

CD8+ T cells

Question 29

key cytokine that drives vitiligo

Answer 29

(IFN)-γ ## Footnote IFN-γ is **secreted by melanocyte-reactive autoimmune CD8+ T cells**, and induces the production of **CXCL10** and other chemokines from keratinocytes, which promote the further recruitment of additional T cells that progressively destroy more melanocytes as the disease spreads

Question 30

drugs that cause depigmentation of skin

Answer 30

* monobenzyl ether of hydroquinone, or monobenzone * 4-tert-butyl phenol * 4-tertbutylcatecho

Question 31

findings signifying presence of repigmentation

Answer 31

perifollicular pigmented macules from pigmented hairs at hair-bearing sites or convex patterns of pigment at lesional borders in glabrous skin ## Footnote Hair-bearing sites without poliosis repigment easily, whereas glabrous skin and lesions containing mostly white hairs respond poorly.

Question 32

Question 33

should be considered the first treatment option in patients with **more than 5%** of the body surface area affected

Answer 33

full-body phototherapy

Question 34

may be used as monotherapy when there is limited surface involvement (less than 5% body surface area)

Answer 34

Topical therapies

Question 35

treatment that achieves highest efficacy for segmental vitiligo in its early phase (ie, disease onset of less than 6 months to 1 year)

Answer 35

Targeted phototherapy

Question 36

it is the only Food and Drug Administration–approved medical therapy for vitiligo

Answer 36

monobenzone

Question 37

Surgery in vitiligo should be reserved for patients with highly stable disease, which has been defined as..

Answer 37

absence of new or growing lesions for **1 to 2 years**

Question 38

Because of their improved donor-to-recipient-site ratio, excellent outcomes in percent repigmentation and color match, as well as improved healing, these grafts are becoming the first-line in surgical management of stable vitiligo

Answer 38

cellular grafts

Question 40

α-melanocyte–stimulating hormone analog

Answer 40

afamelanotide

Question 41

Treatment algorithm for vitiligo

Answer 41

Question 41

Treatment algorithm for segmental vitiligo

Answer 41