醫學治療白蝕 及早防範漫延

醫學資訊

白蝕症（白斑症）總覽與臨床分類——非節段型與節段型之診斷脈絡

白蝕症（又稱白斑症，Vitiligo）是一種常見的獲得性色素脫失性皮膚疾病，在全球範圍內的患病率約為0.5%至2%1。該病的核心病理改變為表皮基底層的黑素細胞（Melanocytes）遭到破壞或功能喪失，導致皮膚無法正常合成黑色素，進而形成邊界清晰的白斑1。儘管白蝕症通常不伴隨劇烈的生理疼痛或瘙癢，但由於病灶多發於面部、頸部及手部等裸露部位，對患者的心理健康與社交生活常造成深遠影響1。
在臨床診斷中，白蝕症主要分為非節段型（Nonsegmental Vitiligo）與節段型（Segmental Vitiligo）兩大類，兩者的病理機制、臨床表現及治療預後存在顯著差異4。

臨床比較維度非節段型白蝕症 (Nonsegmental Vitiligo)節段型白蝕症 (Segmental Vitiligo)
全群患病比例約佔總病例的 85%4約佔總病例的 10%–15%
病灶分布特徵通常呈雙側、對稱性分布，常見於肢端、面部及關節沿單側神經皮節（Dermatome）分布，界限清晰
發病年齡與病程可發於任何年齡，病程多呈慢性漸進性擴散多見於兒童及青少年，發病迅速但較易自限
毛髮受累（白毛症）病程早期毛髮多保持正常，晚期可能變白早期即可累及毛囊深層黑素細胞（Poliosis）
自體免疫關聯高度關聯自體免疫性甲狀腺炎、斑禿等疾病2與系統性自體免疫疾病的關聯性較低
治療反應預後對光療及外用免疫抑制劑反應較好，但易復發5對傳統藥物及光療反應較差，穩定後適合手術7

精準的臨床診斷仰賴皮膚專科醫生的視診與輔助檢查。其中，伍德氏燈（Wood's lamp）檢查是評估早期或淺色皮膚病灶的標準工具8。在伍德氏燈的長波紫外線照射下，脫色區域會發出獨特的亮藍白色螢光，使隱匿的微小病灶與邊界顯形，有助於醫生準確評估病變範圍與疾病活動度8。

Reference

  1. British Association of Dermatologists guidelines for the management of people with vitiligo 2021 | Request PDF - ResearchGate, https://www.researchgate.net/publication/352686774_British_Association_of_Dermatologists_guidelines_for_the_management_of_people_with_vitiligo_2021

  2. Vitiligo - Primary Care Dermatology Society, https://www.pcds.org.uk/clinical-guidance/vitiligo

  3. British Association of Dermatologists guidelines for the management of people with vitiligo 2021*, https://bpg.org.uk/wp-content/uploads/2024/01/Br-J-Dermatol-2021-Eleftheriadou-British-Association-of-Dermatologists-guidelines-for-the-management-of-people-with-vitiligo.pdf

  4. China Medical System: New Drug Application of Ruxolitinib Phosphate Cream for Vitiligo Approved in Hong Kong – CMS, https://web.cms.net.cn/en/2024/11/china-medical-system-new-drug-application-of-ruxolitinib-phosphate-cream-for-vitiligo-approved-in-hong-kong/

  5. Vitiligo: Unmet Need, Management and Treatment Guidelines - PMC, https://pmc.ncbi.nlm.nih.gov/articles/PMC10824320/

  6. Treatment for Nonsegmental Vitiligo | OPZELURA® (ruxolitinib), https://www.opzelura.com/vitiligo/

  7. Vitiligo: Diagnosis and treatment - American Academy of Dermatology, https://www.aad.org/public/diseases/a-z/vitiligo-treatment

  8. Professional Vitiligo Treatment in London | The Thomas Clinic, https://thomasclinic.com/conditions-treatments/vitiligo-treatment/