Vitiligo - External and Internal Eye
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Synopsis
Vitiligo may accompany halo nevi. New-onset vitiligo may be seen in patients with metastatic melanoma. It can occur spontaneously and may herald metastatic disease, or it can be triggered by immunotherapy such as with BRAF inhibitors or PD-1 inhibitors. In the latter setting, it is considered a good prognostic sign. Rarely, vitiligo may be associated with uveitis.
Vitiligo occurs in equal proportions regardless of age, sex, or ethnicity. The natural progression of the disease is unpredictable, ranging from insidious to rapid in onset. Years of stable, nonprogressive disease can be observed with the disease subsequently taking an unexpected rapid trajectory.
While the precise etiology of vitiligo remains debated, two leading hypotheses include: 1) host attack on normal melanocytes; and 2) intrinsic melanocyte defects. While the majority of vitiligo patients are otherwise healthy, an association with autoimmune thyroid dysfunction (hyper- or hypothyroidism) has been demonstrated. In new-onset vitiligo patients with systemic symptoms, thyroid screening with anti-thyroid peroxidase (TPO) antibody and a serum thyrotropin is recommended. Additional associations include endocrinopathies, such as diabetes mellitus and Addison disease, along with other autoimmune processes. Rarely, it may exist as part of polyglandular autoimmune syndrome, particularly type III (Hashimoto thyroiditis, vitiligo or alopecia areata, and/or another organ-specific autoimmune disease).
Codes
L80 – Vitiligo
SNOMEDCT:
56727007 – Vitiligo
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Last Updated:11/09/2023
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