MODUL 2 :

DERMATOVENEROLOGY
CASE 3 :VITILIGO
GROUP 7
WULAN-FADZELY-ARIF AMRI
-SAFUAN ARIF-NADIAH-INSYIRA
-FATIMAH-ANDI ABSHARINA

Prognos
is

Case
review

Complication
s

Anato
my

Physiolo
gy

VITILI
GO

Differentia
l Diagnosis

Etiolog
y

Treatment

Diagno
sis

Pathophysiolo
gy

Classificati
ons

Signs
and
sympto
ms

CASE REVIEW
Woman
30 years old
Whitish spot like white milk
Well defined border in the face
since 2 month ago

Family history of the same

complaint

No history of : injury, atopic

and medication

Physical examination : Mild

illness/ Well-nourished/
Conscious
Vital sign : BP = 120/80; HR =
80 x/menit, RR= 20x/menit;
Tax= 36,7o C
Dermatology status :
i. Location: Face region
ii. Efflorecensce :
Hypopigmented
macules
Laboratory test : KOHBACK
(-), TO TOP
wood lamp (-)

ANATOMY OF SKIN

BACK TO TOP

PHYSIOLOGY OF MELANOCYTE
Located at the epidermis of the skin specifically at stratum
basalis

Also exists in the uvea, inner ear, meninges, bones and heart
Funtion as pigmention of the skin colour
Undergo process melanogenesis to produce melanin

BACK TO TOP

ETIOLOGY
Autoimmune
Genetics/hereditary
Neural theory
Disturbance in oxidant-antioxidant system (release of free
radicals)

Cellular immune mechanisms

BACK TO TOP

PATHOPHYSIOLOGY
Genetics

Melanin biosynthesis
Response to oxidative
stress
Regulation of
autoimmunity

Inheritance of
vitiligo

 Autoimmune

Thyroid disorder
Addison disease
Diabetes mellitus

Increase of
autoantibody
circulating in
the blood
vessels

Destruction of
pigment cells

Decreased
melanin
production

Vitiligo occurs
in
dermatomal
pattern

Neural Theory
chemical
mediators
released from
nerve
endings

 Disturbance in oxidant-antioxidant system

Accumulation
of free radical
toxic on
melanocyte

Increase
nitric acid
level

Destruction
of
melanocytes

BACK TO TOP

SIGNS AND SYMPTOMS

Milky-white macules
Well bordered lesions
Initial lesion located at the face, arms, forearms and
feet

BACK TO TOP

CLASSIFICATIONS
LOCALIZED :
a) Fokal
b) Segmental
c) Mukosal
)
a)
b)
c)

GEENRALISED :
Akrofasial
Vulgaris
Campuran
BACK TO TOP

TREATMENT

NO
RESPON
SE!

< 20%

Top. CS, Immuno

modulator,
Calcipotriol,
Combo

>20%

Phototherapy :
NB-UVB,
PUVA,PUVASOL

NO
RESPON
SE!

Top.PUVA

Skin Graft/
Transplant
melanocyte

Extent ?
Depigmentation
NO
RESPON
SE! /
>50%

BACK TO TOP

PROGNOSIS
Uncertain

BACK TO TOP

COMPLICATIONS
Skin cancer
Hipoacusis
Uveitis

BACK TO TOP

DIFFERENTIAL DIAGNOSIS
1.
2.
3.
4.
5.
6.

Piebaldism
Sindrom Wardenburg
Sindrom woolf
Tinea Vesicolor

Lesi tunggal atau sedikit

Pitiriasis Alba
Nervus depigmentousus (Segmental)

BACK TO TOP