The white spot is one of the reasons why many patients visit the dermatology department, because the term vitiligo has a great reputation, and in the treatment of a certain degree of difficulty, so many patients have a fear of the white spot, but in fact many diseases to can cause or accompany the white spot, the following on the “this white” for a brief introduction.
I. Congenital pigment loss skin diseases
(1) Albinism
This disease is a congenital disease, and tyrosinase genetic defects related. The patient’s skin, hair and eye pigmentation is lacking, and the skin is milky white or pink and easily sunburned. The iris and choroid are also red due to lack of pigment. Some patients have congenital malformations such as refractive error, strabismus, and nystagmus.
(2) Ocular and cutaneous albinism
It is a rare genetic disorder in which the skin and hair are extremely white and do not darken with sunlight, and there is often nystagmus and visual defects and lack of pigment in the fundus.
(3) Albinism-like disease
Early onset, can occur at birth, the skin is milky white or pink, with increasing age can produce a little pigment, hair since childhood white yellow, with growth and development gradually cream, yellow, light brown; visual impairment, nystagmus and photophobia.
(4) Mottled disease
A rare genetic skin disease. Because the lesion involves melanocytes, the most characteristic manifestation of the disease is a triangular or diamond-shaped white spot in the central part of the forehead, accompanied by limited white hair across the hairline. The white hair has a reticular appearance. Sometimes the frontal white hair is the only manifestation of the disease. It may be accompanied by iris abnormalities, deafness, abnormal mental development, and hare lip.
Acquired depigmented skin diseases
(1) Discoid lupus erythematosus
It is an immune-related chronic recurrent skin disease, which may also present with white spots on the skin, but often with characteristic skin pathology.
(2) Idiopathic punctate leukoplakia
This disease is distinguished from vitiligo, lichen planus, and secondary leukoplakia by the presence of white patches with clear margins that do not continue to expand.
(3) Age-related leukoplakia
It is mainly due to the degeneration and aging of local skin melanocytes and reduced tyrosinase activity, which is one of the degenerative skin manifestations in the elderly. It is one of the manifestations of skin degeneration in old age. It is manifested as multiple, round or irregular milky white spots on trunk and limbs. With the increase of age, the number gradually increases, does not expand and fuse, no conscious symptoms, clear boundaries.
(4) Progressive mottled hypopigmentation of the trunk
The etiology is unknown, mostly seen in female patients. (4) Progressive hypopigmentation of the trunk (especially on the upper back) with unclear boundaries, 1-75 px in diameter, more in number, symmetrically distributed. The surface of the lesions is non-scaly and localized without pain or itching. The hypopigmented spots are clearer when examined with Wood’s lamp.
(5) Symmetrical progressive leukoplakia
Mostly seen in young people, mostly appearing as white spots of 2-8mm in diameter on the forearm extensions and calf front, not occurring on the trunk and face. The boundaries are clear, no conscious symptoms, no expansion or fusion, and the white spots can last for life.
Third, simple pigment reduction class of skin disease
(1) white furfuraceous rash
Also known as simple pityriasis, folk or called “roundworm spot” “peach fever”. The disease usually occurs in children or adolescents, mainly located in the face, the lesion at first is a round light red spot of varying size, covered with furfuraceous scales, later pigment reduction, the border is unclear. There are usually no conscious symptoms.
(2) Ito hypomelanosis
This disease is more commonly seen in women,1 and more than half of the cases develop at birth or in infancy. It occurs mostly on the trunk or extremities, and can be seen as linear or band-like pigment loss spots with clear boundaries and a strange shape, resembling the ink-like spots of pigment incontinence, often accompanied by other developmental abnormalities, such as strabismus, dental abnormalities, mental retardation, and epilepsy.
(3) Non-pigmented nevus
This disease occurs early, usually at birth or soon after birth, and expands proportionally with age. The damage is often distributed along the nerve segments and appears as limited or generalized hypochromic spots with irregular, non-pigmented edges, which are not as obvious as vitiligo. Sometimes the white spots are mixed with light brown corn to lentil freckle-like spots with normal sensation, and if the surrounding skin is pressed to make it ischemic, the boundary between the affected area and the surrounding skin still exists. The skin lesions persist for life.
(4) Anemic nevus
This is a kind of congenital hypochromia. It is round or irregular in shape, with clear boundaries, and can occur on any part of the skin. The skin of the lesion is not red when you rub the affected area with force. If you press the surrounding skin to make it ischemic, the boundary between the lesion and the surrounding skin disappears. In contrast, vitiligo is congested when the affected area is rubbed with force.
(5) Pseudo-syphilitic leukoplakia
The cause of the disease is unknown and it occurs in middle-aged men. Clinically, it is characterized by oval or irregular-shaped light white patches on the neck, chest and back, and proximal extremities (less frequently involving the face). The patches may fuse with each other to form larger pieces, indicating smoothness without scaling, inconspicuous boundaries with normal skin, and no pigmentation at the edges. The number is large, the course of the disease is chronic, and there are no conscious symptoms.
Fourth, secondary leukoplakia-like skin disease
(1) post-inflammatory leukoplakia
Can be caused by a variety of inflammatory skin diseases, such as psoriasis, lichen planus, pityriasis rosea, etc., in its primary disease can be left after the fading of the hypopigmented spots, after a few weeks or months gradually recovered.
(2) Occupational white spots
Rubber product workers, people who often wear rubber gloves or other rubber bands at work often have hypopigmented patches at the contact site without any inflammation in advance. This kind of hypopigmented patches is very similar to vitiligo, except that the shape is irregular and the edges are not very clear. In addition, workers who are often exposed to quicklime may also develop hypopigmented patches at the site of trauma, mainly on the back of the hands.
(3) Solar leukoplakia
After repeated exposure to sunlight in summer, clear-cut hypopigmented spots appear on the chest, sometimes fusing into patches, without conscious symptoms, and usually fading on their own.
(4) Stellate spontaneous pseudopurpura
It often occurs in people who are exposed to sunlight for a long time, such as athletes or other outdoor workers. The majority of the scar-like pigment loss spots occurring on the back of the hand, arm extensions, are actually not scarring, and patients are often accompanied by senile purpura.
Five, can be accompanied by atrophic leukoplakia class skin disease
(1) Sclerosing atrophic moss
It is a chronic inflammatory skin disease. The lesions are often well-defined white patches surrounded by edematous erythema, with hard, shiny skin and intense itching. The pathological changes of the disease are specific, showing lymphocytic infiltration, follicular keratosis, spiny layer atrophy, basal cell liquefaction degeneration, and purified changes in the superficial dermis.
(2) Limited scleroderma
The lesions are white or ivory-colored, localized hardening, and then gradually atrophy, without obvious conscious symptoms. Histopathology is specific, early stage often has obvious inflammation, late stage often no obvious inflammation, normal epidermis, dermis flesh layer collagen fiber thickening, red staining, appendage reduction or disappearance. The prognosis is often good.
(3) Atrophic lichen planus
It is common in adults, with obvious pruritus. It appears as flat and shiny purple-red or purple-blue papules, corn to green bean size or larger, round or round-like, with clear borders and a layer of smooth and shiny wax-like film scales on the surface. The prognosis is usually good.
(4) White atrophy
Also called Milian white atrophy. It is common in young and middle-aged women. Small erythematous patches appear on the lower extremities, hands, especially on the back of the feet and ankles, with petechiae, hemorrhagic papules, blisters, crusts, and then superficial necrosis or ulcers; after a few weeks of healing, smooth ivory-white atrophic patches are formed, varying in size, with indistinct margins, surrounded by more colored capillary dilatation, and often accompanied by a few purpura. At present, it is mostly considered as primary capillaritis.
(5) Mottled disease
A rare genetic disease caused by KIT mutation and SLUG (also called SNAI2) gene deletion. The clinical features are triangular or diamond-shaped white spots in the frontal midline, often combined with white hair, called white frontal hair, symmetrical distribution of melanin-depleted white spots on the chest, abdomen and mid-extremities, interspersed with melanin patches, stable lesions, and non-pigmented borders.
Six, with certain infectious light pigmentation performance of the skin mucosal disease
(1) lichen planus
It is commonly known as “sweat spot”. Generally, there are no conscious symptoms. The lesions are initially follicular pale erythematous, and then gradually expand and are covered with fine scales. The disease often appears as a hypopigmented spot, which can last for months to years after the disease is cured.
(2) Leprosy and lepromatous leukoplakia
Leprosy can occur with skin sensory changes of depigmentation, but in the early stage of sensory changes may not be obvious, should pay attention to the difference with vitiligo. Hypopigmentation in leprosy may be due to reduced melanocyte activity, which is related to the invasion of melanocytes by Mycobacterium leprae; treatment of leprosy can regenerate pigment.
(3) Syphilis and syphilitic leukoplakia
White spots usually occur simultaneously with other manifestations of second-stage recurrent syphilis (roseola, papules, flat warts, hair loss, etc.) and positive syphilis seropositivity. The white spots can subside after anti-syphilis treatment.
(4) Pinta disease
Infectious disease caused by Pinta spirochete infection. It is endemic in Central and South America.
(5) Onchocerciasis
Mainly endemic in Africa.
VII. Skin diseases with pigment abnormalities
(1) Pancytopenia pigmentosa
It is a genetic disease. Onset begins at birth or in early childhood. The lesions are most pronounced on the trunk and abdomen. The lesions are most obvious on the trunk and abdomen. They appear as hyperpigmented patches of varying shades, sizes and shapes. Pigmented spots are visible on the sclera.
(2) Hereditary symmetrical pigmentary anomalies
Idiopathic melanopenia is associated with mutations in the ADAR1 and DSRAD genes. The clinical features are patchy symmetrical white spots on the extremities, especially on the dorsum of the hands and feet.
(3) Marshall-White syndrome (Bier’s anemia), vascular pitting pigmentation
The lesions are pale white spots surrounded by diffuse red spots or cyanosis, mostly on the ends of the limbs, palms and dorsum of the feet, and the white spots are more prominent if the affected limbs are down for a period of time, and the white spots can disappear when the affected limbs are raised, independent of temperature, and there is no obvious difference between winter and summer, while vascular pitting of the skin is obvious at low temperatures. Vascular punctate discoloration shows the marble-like appearance of erythema and white spots intermingled at the end of the extremities, which is more common in women.
VIII. Heterochromia-like skin diseases
(1) Civatte skin heterochromia
Also known as reticular skin heterochromia. May be related to endocrine disorders, sun exposure and photosensitive substances in cosmetics. Patients are mostly middle-aged, pre- and post-menopausal women. It mostly occurs on the face and neck, anterior neck, and may appear symmetrically as reddish-brown to bronze patches, consisting of reticulopigmentation and dilated capillaries, interspersed with mildly atrophic pale white spots.
(2) Hereditary sclerosing cutaneous heterochromatosis
It is a genetic disease. It often develops in infancy and early childhood. The axillary, elbow and other flexural areas are initially vasodilated, followed by hyperpigmentation and then reticulated atrophic light-colored spots, accompanied by elevated hard hyperkeratotic and sclerotic bands of skin.
(3) Hereditary keratotic skin heterochromatosis of the extremities
It occurs mostly in infants, and blisters or pustules may appear on the hands and feet, more often on the flexural skin, and gradually fades as the child grows up. Except for the scalp, face, and ears, diffuse associated linear or reticular skin heterochromatosis gradually appears in other areas. Firm mossy keratotic papules may appear on the palms and toes, elbows, knees, and distal extremities, which do not subside for life.
IX. Skin diseases with white manifestations of visceral or systemic damage
(1) tuberous sclerosis
Some patients have a family history of the disease, which often develops before the age of 5 years. There are four characteristic damages: 1) Pringle sebaceous adenoma; 2) perineural fibroma; 3) augmented fish skin spots; 4) oval or striated lobulated white spots.
(2) Phenylketonuria
A genetic disease caused by the lack of phenylalanine oxidase in the patient’s liver. The disease occurs in infancy and early childhood, the affected children have white skin, light yellow hair, and systemic symptoms mainly manifest as mental retardation, repeated convulsions, high muscle tone, back and forth shaking of the trunk, and short pace when walking, like an ape.
X. Leukoplakia syndrome
(1) Unilateral retinal vitiligo syndrome
Also known as ocular-skin-ear syndrome, it may be related to pigment sensitization. Unilateral creamy white patches may appear on the face of adolescents. The hair on the same side as the white spots may turn gray or white. Eyelashes often turn white, there may be visual deficits, and there may be bilateral sensory deafness.
(2) Harada disease (Fugate Koyanagi syndrome)
The disease often develops after the age of 20. The pigment changes are mostly persistent.
(3) Oculocerebral syndrome with hypopigmentation
It is a genetic disease with pure white skin resembling albino pancytopenia since childhood, accompanied by small eyes, thin corneal opacity, nystagmus, delayed physical development and mental disorders.
(4) Haptorrhaphy-Gross-Mukusick-Breen syndrome
Also known as hypopigmentation-oculocephalic syndrome, the parents are mostly consanguineous. The skin appears milky white or pink after birth, and may be accompanied by freckles and pigmented nevi. The hair is pure white to pale yellow with a metallic grayish-yellow sheen. Small eyes with cloudy corneas, cataracts, blindness, and nystagmus may occur; in severe cases, physical and mental retardation, and gingival fibroids may be present. There is a tendency of skin cancer due to lack of pigment protection.
(5) Leukocyte abnormal albinism syndrome
Also known as Begnez-Cesar syndrome. The whole body or a few patients have reduced skin and hair as well as eye pigmentation in parts of the body. The skin is characteristically white with a silvery gray color in sunburned areas. The hair is silvery white or light yellow. Photophobia of both eyes, reduced retinal pigmentation, and mobile nystagmus may occur with light exposure of the eyes; recurrent bacterial or viral infections of the skin and respiratory tract may occur. Extensive chronic infections often leave atrophic scarring; the liver is moderately enlarged, and hemolytic anemia and thrombocytopenia may occur due to hypersplenism.
(6) Pigmentary abnormalities-deafness syndrome
Also known as albino-deafness syndrome, with postnatal onset, albino changes such as fair skin, light yellow or silvery hair, strabismus, photophobia, nystagmus, and lack of pigmentation in the iris fundus; congenital sensorineural deafness. Bilateral dysplasia and sparse short eyebrows. More susceptible to solar keratosis, dermatoglyphics, and skin cancer.
(7) Albinism-deafness syndrome
Also known as zipkowski-Margolis syndrome, the cause is unknown, after birth, the whole body skin is creamy white or pink, the hair is pale white or yellowish. It is prone to photosensitivity reactions after sun exposure and sometimes heliokeratosis or even malignant changes. Photophobia and nystagmus. With deafness and mute.
(8) Albinism-hematocriticism-deafness syndrome
Also known as Hermansky-Pudlak syndrome. Unknown etiology, onset at birth, oculocutaneous albinism or pancytopenia, nystagmus, photophobia, history of rhinorrhea, gingival bleeding hemoptysis or various bleeding.
(9) Waardenburg-Klein syndrome
It may be a variant of pemphigus characterized by lateral ectopia of the medial canthus and tear dots, wide and high nasal roots, congenital deafness, iris heterogeneity, and white frontal hair, which is clinically similar to vitiligo.
(10) Deafness-mottled syndrome
Also known as Woolf syndrome, the etiology is unknown. The skin is mottled with milky white spots since birth, and the hair is mottled with white spots more obviously, and the rest of the hair is normal in color. There is mild astigmatism in the eyes and plexiform hyperpigmentation in the fundus. There was incomplete neurogenic deafness.