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Disorders of Pigmentation

»	Are some disorders of pigmentation markers for systemic disease?
»	How do you diagnose a pigmentation disorder?
»	What are the important elements of a skin examination of a patient with a pigmentation disorder?
»	What is a Wood’s lamp?
Leukoderma: partial or complete loss of skin pigmentation
»	Name some heritable forms of leukoderma.
»	Name the skin disorder that manifests with complete loss of skin pigmentation.
»	Describe the clinical appearance of the skin lesions in vitiligo.
»	When does vitiligo have its onset?
»	Do any factors influence the onset of vitiligo?
»	Is vitiligo treatable?
»	What is piebaldism?
»	What is albinism?
»	How does albinism differ from the other inherited leukodermas?
»	Can disorders of amino acid metabolism cause leukoderma?
»	How do chemicals cause skin depigmentation or skin hypopigmentation?
»	Can patients with nutritional disorders suffer from leukoderma?
»	What disorders should the clinician consider in a patient with hypopigmented macules and patches?
»	What is tuberous sclerosis?
»	What is nevus depigmentosus?
»	How does nevus depigmentosus compare to hypomelanosis of Ito?
»	Which infectious disorders can have associated leukoderma?
»	Describe the pigmentation changes seen with the treponematoses.
»	What cutaneous lesions are seen with Hansen’s disease?
»	Why is lesional skin of tinea versicolor frequently hypopigmented?
Melanoderma: abnormal darkening of the skin
»	What are lentigines? What heritable disorders manifest these?
»	Why is it important to identify patients with Peutz-Jeghers syndrome?
»	Describe the clinical manifestations of Moynahan’s syndrome.
»	Are there pigmentation disorders associated with neurofibromatosis?
»	Do any other disorders manifest with CALM?
»	What is Becker’s melanosis?
»	What is a nevus spilus?
»	Do any natural factors stimulate human epidermal pigmentation?
»	What drugs are used to stimulate skin pigmentation? How do they work?
»	Can other drugs cause increased skin pigmentation?
»	Can endocrine and metabolic disorders cause altered skin pigmentation?
»	Can forms of radiation other than ultraviolet radiation cause increased skin pigmentation?
Blue-gray dyspigmentation
»	Are there other types of dyspigmentation besides leukoderma and melanoderma?
»	Name the different types of hyperpigmentation due to excess numbers of derma melanocytes.
»	Differentiate a nevus of Ota from a nevus of Ito.
»	What types of hyperpigmentation are due to dermal melanin deposition?
»	How does erythema ab igne occur?
»	Are there any metabolic disorders associated with nonmelanin skin dyspigmentation?
»	What pigmentation disorders are associated with heavy-metal deposition in the dermis?
»	What drugs can deposit in the dermis and cause pigmentary changes?

Name the skin disorder that manifests with complete loss of skin pigmentation.

Vitiligo is a depigmenting disorder due to loss of epidermal melanocytes. There are both familial and nonfamilial forms, and the overall incidence is 1% in the United States. Vitiligo has been reported to be associated with autoimmune disorders, including thyroid disease and diabetes mellitus type 1. The pathogenesis is not totally understood. Curiously enough, patients have both circulating antimelanocyte antibodies and skin-homing melanocyte-specific cytotoxic T lymphocytes. How these two portions of the immune system interact to result in melanocyte destruction is not understood. Vitiligo affects all races and affects both sexes equally.

Halder RM, Chappell JL: Vitiligo update, Semin Cutan Med Surg 28:86–92, 2009.