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Vitiligo

★ CMTO Exam Focus

Vitiligo is an acquired autoimmune pigmentary disorder characterized by progressive loss of melanocytes, resulting in well-circumscribed, depigmented (white) patches on the skin. It affects 0.5-2% of the population worldwide, with no sex or race predilection, though more cosmetically apparent in darker skin tones. Vitiligo is NOT contagious, does not affect skin integrity, and is NOT a contraindication to massage. It is, however, associated with other autoimmune conditions and can cause significant psychological distress.

Pathophysiology

  • Autoimmune (most accepted): Cytotoxic T-lymphocytes destroy melanocytes in the epidermis
  • Genetic component: Multiple susceptibility genes. Family history in 20-30% of patients
  • Koebner phenomenon: New depigmented patches can develop at sites of skin trauma (cuts, burns, friction)
  • Non-segmental (85-90%): Bilateral, symmetrical patches. Progressive
  • Segmental: Unilateral, follows a dermatome. Earlier onset. Tends to stabilize
  • Hair in affected areas may also turn white (leukotrichia/poliosis)
  • Associated autoimmune conditions: thyroid disease, type 1 diabetes, pernicious anemia, Addison disease

Signs and Symptoms

Hallmark Indicators

  • Well-circumscribed, milky-white macules or patches with distinct borders
  • Bilateral and symmetrical distribution (non-segmental type)
  • Common sites: face (perioral, periorbital), dorsal hands, wrists, elbows, knees, genitalia, axillae
  • Progressive enlargement and coalescence over time
  • No pain, itching, or skin texture change (distinguishes from fungal infections)
  • Significant psychological and social impact

Red Flags and Rule-Outs

  • Distinguish from tinea versicolor (scaly patches caused by yeast) and post-inflammatory hypopigmentation (follows prior skin injury/inflammation)
  • Vitiligo has NO scaling, itching, or textural change — unlike fungal infections
  • New vitiligo in an adult: Screen for associated autoimmune conditions (thyroid, diabetes, pernicious anemia)
  • Depigmented areas are more susceptible to sunburn due to absence of melanin

MT Considerations

  • No contraindication: Vitiligo does not affect skin integrity. Full massage is appropriate
  • Lubricant: No special requirements — depigmented skin has same texture and integrity as surrounding skin
  • Sun sensitivity: Counsel clients to apply sunscreen to depigmented areas
  • Psychological sensitivity: Can cause significant distress, especially in adolescents and visible areas. Be sensitive and professional
  • Do not confuse with infection: White patches with no scaling, itching, or textural change = vitiligo, not fungal
  • Associated conditions: Screen for symptoms of autoimmune comorbidities (fatigue, weight changes suggesting thyroid disease)

CMTO Exam Relevance

  • Autoimmune pigmentary disorder — NOT contagious, NOT an infection, NOT contraindicated
  • Depigmented areas are more susceptible to sunburn
  • Associated with other autoimmune conditions (thyroid, diabetes, pernicious anemia)
  • Distinguish from tinea versicolor and post-inflammatory hypopigmentation
  • Koebner phenomenon: new patches at sites of skin trauma

Key Takeaways

  • Vitiligo is an acquired autoimmune disorder causing progressive melanocyte loss and well-defined white patches
  • Not contagious, not painful, and not a contraindication to massage
  • Bilateral, symmetrical distribution on face, hands, and areas of friction
  • Associated with other autoimmune conditions (thyroid disease, diabetes, pernicious anemia)
  • Significant psychological impact — sensitivity and professionalism are important

Related Conditions

Sources

  • Norris, T. L. (2019). Porth's essentials of pathophysiology (5th ed.). Wolters Kluwer.
  • Tortora, G. J., & Derrickson, B. H. (2020). Principles of anatomy and physiology (16th ed.). Wiley.
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