Thread by @skinandall_

#dermatologyteaching for students and residents
Quick one.
Yesterday was World vitiligo day. A condition with an unknown cause however largely attributed to autoimmune destruction of the melanocytes leading to absence of pigment in the affected areas.

If you are asked for differentials...please do not let albinism feature in that list. It is NOT usually a differential of vitiligo. Except maybe in vitiligo universalis where almost the whole skin is affected.

Albinism refers to a group of inherited disorders where there is a problem with melanin synthesis due to the deficiency of some enzymes or proteins in the melanin production pathway.The melanocytes are fine, it is the melanin production that is absent. It doesn't occur in patches

There are different variants of albinism. The sine qua non of albinism is that the eye is always affected. You can have ocular albinism (OA) without having cutaneous albinism Oculocutaneous albinism (OCA) is of four major types. OCA 1 to 4. There are different clinical spectrum

OCA 2 is the one that has different variants. You can have some albinos that can still tan slightly (looking slightly reddish) and some that will remain almost startlingly white. The eye color can range from hazel to other colors like blue. Why do you think the eye is affected?

Because there's melanin in the eye too.
The first differential of vitiligo should be piebaldism (history will differentiate for you) but this is a congenital thing. Vitiligo is ACQUIRED. Patients are not born with it. Others are chemical leukoderma, halo nevus, scleroderma

Again some syndromes like Alezzandrini, Vogt-Koyanagi-Harada may be associated with vitiligo.
Remember to take a history and screen for other autoimmune diseases.
Did you know that all races, animals and even plants can have albinism?
It is important to counsel and reassure pxs

Alezzandrini syndrome- facial vitiligo, poliosis, deafness, and unilateral visual changes.
VKH- vitiligo, severe uveitis, aseptic meningitis, dysacusis, tinnitus, poliosis, and alopecia.
There are different variants of vitiligo.The one shown in the picture is acrofacial vitiligo

You can have generalized vitiligo (like the picture online a few days ago), segmental vitiligo (almost strikingly on a dermatomme), vitiligo universalis (almost everywhere but may spare the hands and face). No single treatment can boast of an assurance of complete resolution.

It is important to let your patient know this. Counsel them please. And let them know they're beautiful. Sunscreen use is important. But the sun helps repigmentation too.
Sunscreen use and all other sun protection in albinos is of paramount importance.They're prone to photoageing

And skin cancers especially the non melanoma skin cancers like squamous cell and basal cell carcinoma.
Let your patients know that vitiligo or albinism is not attacks from home. Know the inheritance of albinism so you can explain properly.

Two completely dark skinned people can give birth to an albino. An albino can give birth to a dark skinned baby. It is inherited in an autosomal recessive fashion so the gene has to be present in both families.

I can't believe I said "quick one"🤦‍♀️
Picture from Google image

P.S...The sun is not friends with albino skin. The risk of skin cancer is similar to Caucasian skin (even more at risk as most have no melanin per se) so that melaninated protection is absent.
So sun protection is paramount because of the risk of sun induced skin cancers,