Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Dermatology and Venerology

Background: Vitiligo is an acquired chronic depigmenting disorder with an estimated prevalence of 0.5%. Vitiligo received many classifications over the years, with the acral/non acral being one of the most commonly dealt with. Aim of work: Owing to the presumed practical benefits one could achieve from a proper classification, the current study aimed to sub-classify the acral vitiligo, particularly the hands into distinct clinical subtypes.Patients and methods: 720 vitiligo patients were recruited. Photos were taken for hands of patients with acral vitiligo for both dorsal and palmer surfaces under both visible and wood's light. Photos were later studied by 5 independent dermatologists, and sites of vitiligo affection were marked. Only areas that were found common among at least 3 of them were finally marked as being involved. Hands showing similar affection sites were arranged together, and those found to be repeated in {u2265}5% were considered a pattern.Results: The incidence of acral vitiligo was 56.38 %. Among the 406 acral vitiligo patients, 5 types were represented by percentages high enough to be considered a pattern. The "knuckle" pattern (43.84 %), "no rule" pattern (27%), "periungual" pattern (14.41%), "inversed knuckle" pattern (8.1%) and "glove" pattern (6.6%). Conclusion: Acral vitiligo is not to be considered as one unit, with 5 main distinct clinical types. Each one has been proposed unique predisposing factors, clinical criteria, prognosis and therapeutic plan. The current study offered a further practical step to better understand how to deal with acral vitiligo and eventually reach better outcomes

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