VITILIGO – MANAGEMENT AND THERAPY Edited by Kelly KyungHwa Park and Jenny Eileen Murase Vitiligo – Management and Therapy Edited by Kelly KyungHwa Park and Jenny Eileen Murase Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Used under license from Shutterstock.com First published December, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Vitiligo – Management and Therapy, Edited by Kelly KyungHwa Park and Jenny Eileen Murase p. cm. ISBN 978-953-307-731-4 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Introductory An Illustrated Guide to Clinical Vitiligo Chapter with Expert Opinion 1 Kelly KyungHwa Park and Seung-Kyung Hann Chapter 1 Genetic Epidemiology and Heritability of Vitiligo 17 Abdullateef A. Alzolibani, Ahmad Al Robaee and Khaled Zedan Chapter 2 The Pathogenesis of Vitiligo 31 Marlene Dytoc and Neel Malhotra Chapter 3 The Psychosocial Aspects of Vitiligo: A Focus on Stress Involvement in Children with Vitiligo 57 Liana Manolache Chapter 4 Ultraviolet B (UVB) Phototherapy in the Treatment of Vitiligo 69 Kelly KyungHwa Park and Jenny Eileen Murase Chapter 5 A Comparison of NB-UVB and PUVA in the Treatment of Vitiligo 95 Jiun-Yit Pan and Robert P.E. Sarkany Chapter 6 Systemic Corticosteroids in Vitiligo 107 Binod K. Khaitan and Sushruta Kathuria Chapter 7 Segmental Vitiligo 117 Ji-Hye Park and Dong-Youn Lee Chapter 8 Vitamin D and Vitiligo 127 Sang Ho Oh and Miri Kim Chapter 9 Topical Calcineurin Inhibitors in the Treatment of Vitiligo 135 Cristina Caridi, Andrew Sohn and Rita V. Patel VI Contents Chapter 10 Complementary and Alternative Medicine for Vitiligo 143 Jimi Yoon, Young-Woo Sun and Tae-Heung Kim Preface Vitiligo is a common yet frequently misunderstood disease. Despite the historical and cultural significance of vitiligo, as well as its impact on the lives of those affected, the pathogenesis, clinical presentation, and management of vitiligo remains elusive. The expertise and knowledge of an international group of experts and clinicians well-versed in vitiligo have been gathered to provide the reader with a practical guide to vitiligo. We hope that the reader can gain insight into vitiligo as a disease and its management, as well as demonstrate the ability to apply the fundamental concepts covered in this book. Our wish is that this book will be a concise yet comprehensive tool for the dissemination of the newest developments and therapeutic advances in vitiligo. Acknowledgements I am grateful for the unwavering support of my co-editor and mentor, Jenny Murase, M.D., as well as my mentors, John Koo, M.D., and Rebecca Tung, M.D. As always, I am thankful to my parents, Youn Wook Park, M.D., and Kay KongBum Shin-Park, Ph.D., my sister Sonja Park, M.A., and Edgar, for their endless encouragement. I also wish to acknowledge the nurses and staff at the University of California San Francisco, Psoriasis and Skin Treatment Center, who make every day pleasant for physicians and patients alike. Kelly KyungHwa Park, MD Department of Dermatology University of California San Francisco San Francisco, California USA X Preface To my Katsuyuki, Emi, Lilia, and Kento for reminding me of the richness of life and the joy of laughter, and to my parents for teaching me how to give to others: for nothing is more important than family! Jenny Eileen Murase, MD Palo Alto Foundation Medical Group Department of Dermatology Mountain View, California USA [...]... Blaschko’s lines Mixed vitiligo Combination of segmental vitiligo and nonsegmental vitiligo Focal vitiligo Localized, solitary depigmented macule(s) Acrofacial vitiligo Localized patches Universal vitiligo Extensive disease with majority of the body involved Mucosal vitiligo Typical macules of vitiligo Table 1 Glossary of Vitiligo 3.1 Non-segmental vitiligo NSV can occur at any age and generally has a... Trichrome vitiligo shows an intermediate tan depigmentation between lesions of amelanosis and normal skin (Figure 3) Quadrichrome vitiligo has a dark brown Fig 3 Trichrome vitiligo 6 Vitiligo – Management and Therapy coloration at lesion margins or perifollicular areas Pentachrome vitiligo includes the presence of a blue-gray area, totaling 5 shades Trichrome, quadrichrome, and pentachrome vitiligo. .. involvement complicates nearly 50% Fig 5 Segmental vitiligo Fig 6 Unilateral segmental vitiligo 8 Vitiligo – Management and Therapy of cases, and can affect the scalp, eyebrows and lashes, groin, and axillae (Hann & Lee, 1996; Hann, et al., 1997) Extensive SV is very rare, and presents with involvement of over 50% of the body surface area (BSA) of the extremities and torso with facial sparing that is most... characteristics of vitiligo, including its ability to impair quality of life, can guide management 11 References Achauer BM (2003) Carbon dioxide laser resurfacing and thin skin grafting in the treatment of stable and recalcitrant vitiligo Plast Reconstr Surg 112: 1176 Agarwal G (1998) Vitiligo: an under-estimated problem Fam Pract 15 Suppl 1: S19-23 14 Vitiligo – Management and Therapy Albert DM,... clinical and/ or histopathologic diagnoses of vitiligo were evaluated; :39 boys and 41 girls The mean age at first visit was 7.9 years and the mean age at disease onset was 5.6 years The children were compared with a control group of 422 adults with vitiligo Children comprised 16% of the total vitiligo patients and adults comprised 84% A family history of vitiligo was found in 11 (13.8%) of 20 Vitiligo – Management. .. pattern, and can follow a rapid or protracted time course Lesions can be distinguished by Wood’s lamp examination or made more apparent by tanning of surrounding normal skin Vitiligo is usually asymptomatic, although pruritus may be reported, particularly when lesions are spreading 2 Vitiligo – Management and Therapy Vitiligo can appear anywhere on the body and mucous membranes The face, dorsal hands,... (Wittke-Thompson et al., 2007) 3.2 Genetic basis of vitiligo Genes play a role in all aspects of vitiligo pathogenesis, even in response to environmental triggers Typical generalized vitiligo behaves as a “complex trait”, meaning it is a polygenic, multifactorial disease involving multiple genes and non-genetic factors Only a few vitiligo 24 Vitiligo – Management and Therapy susceptibility genes have been identified... by Lerner as generalized vitiligo, and there is growing support for restoration of this term (Lerner, 1959) South American vitiligo experts insist that segmental vitiligo should be referred to as unilateral vitiligo and that non-segmental should be bilateral vitiligo However, this concept of classification is not accepted by the whole international vitiligo consensus group NSV and SV are thought to differ... Differences between familial and sporadic cases of vitiligo J Eur Acad Dermatol Venereol Kanwar A, Parsad D & De D (2010) Mucosal involvement in vitiligo: a comprehensive review of 241 cases J Eur Acad Dermatol Venereol Koga M (1977) Vitiligo: a new classification and therapy Br J Dermatol 97: 255-261 Koga M & Tango T (1988) Clinical features and course of type A and type B vitiligo Br J Dermatol 118:... Blackwell Science Ortonne JP (2008) Vitiligo and other disorders of hypopigmentation In: Dermatology, ed Jean L Bolognia, Joseph L Jorizzo, Ronald P Rapini, 913-938 New York, NY: Mosby 16 Vitiligo – Management and Therapy Papadopoulos L, Bor R & Legg C (1999) Coping with the disfiguring effects of vitiligo: a preliminary investigation into the effects of cognitive-behavioural therapy Br J Med Psychol 72 ( . VITILIGO – MANAGEMENT AND THERAPY Edited by Kelly KyungHwa Park and Jenny Eileen Murase Vitiligo – Management and Therapy Edited by Kelly KyungHwa Park and Jenny. Fig. 5. Segmental vitiligo Fig. 6. Unilateral segmental vitiligo Vitiligo – Management and Therapy 8 of cases, and can affect the scalp, eyebrows and lashes, groin, and axillae (Hann. spreading. Vitiligo – Management and Therapy 2 Vitiligo can appear anywhere on the body and mucous membranes. The face, dorsal hands, intertriginous areas, umbilicus, sacrum, and anogenitial