A Case of Vitiligo involving the 
whole Surface. 
BY 
HENRY W. STELWAGON, M. D., 
Physician to the Philadelphia Dispensary for Skin Diseases, Chief of the Skin Dispensary of the 
Hospital of the University of Pennsylvania, etc. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. 
July, 1885. Extracted from the 
American Journal of the Medical Sciences for July, 1885. 
A CASE OF VITILIGO INVOLVING THE WHOLE SURFACE.1 
By HENRY W. STELWAGON, M.D., 
Physician to the Philadelphia D i s p eh saryTor Skin bTseases, Chief of the Skin 
Dispensary of the Hospital of the University of Pennsylvania, etc. 
The patient, a male, aged 37, whose disease will be briefly sketched in 
this paper, came under my care in June of 1880. He is of Austrian birth, 
coming to this country when sixteen years old. Is of robust health, dark 
complexion, and always had a naturally dark skin. In 1870 or 1871 he 
was taken down with an attack of smallpox, from which he made a good 
recovery, with but a moderate degree of scarring. From the time of his 
arrival in this country up to ten months ago, he followed the occupation 
of a longshoreman. 
Six months after the attack of smallpox he noticed a few small pea- 
sized pale spots on the face, to which, however, he gave but little thought, 
and no attention. Several months later on, spots of the same character 
appeared on the backs of the hands, while those on the face had become 
more noticeable from the fact that the surrounding adjacent skin had 
grown considerably darker than that on other parts of the body. As 
summer advanced, although there was only a slight increase in the size 
of the spots, yet they had become even more conspicuous from the general 
sun-bronzing resulting from the constant exposure which his occupation 
necessitated; the paleness of the spots remained unaffected. During the 
latter part of the summer the patches continued to grow slowly; never at 
a stand, although at this time, and for several years subsequently, the in- 
crease from month to month was barely perceptible. 
So the disease progressed until about six months before his coming 
under my observation, when it began to extend much more rapidly, show- 
ing itself upon the arms, legs, and trunk, while the individual patches 
themselves grew much larger. There were, as usual, no subjective symp- 
toms. Dyspepsia was the sole trouble he had during this time; this was 
1 Read at the Eighth Annual Meeting of the American Dermatological Association, 
Highland Falls, New York, August 29, 1884. 2 
tolerably severe, and persisted throughout. In fact it had been present 
before the patches appeared, and still persisted. At the time of his coming 
under my care the disease had involved a greater portion of the whole 
surface. The eyes were ringed with a border at least two-thirds of an 
inch deep; other parts of the face were also affected. The backs of the 
hands were almost completely occupied with the characteristic pale patches. 
The forearms, the arms, legs, and thighs, as well as the feet and trunk, 
were likewise involved. Immediately surrounding the patches the skin 
was considerably pigmented, to such a degree, indeed, as may be looked 
upon as extraordinary even for a case of vitiligo. The pigmentation ex- 
tended several inches beyond the edges of the leucodermic patches, becom- 
ing less intense as the distance from the patches increased, and gradually 
fading away into the normal skin. Between the pigmented borders of the 
patches the skin was of the natural color. The patches, as the patient 
stated, were extending rapidly, and many were becoming confluent and 
covering large areas of surface ; in fact, the disease, the past six months, 
according to the statement made, had involved several times as much sur- 
face as the seven or eight years preceding. The hairs on the parts affected 
were to a great extent white or grayish. Several tufts of white hair could 
be seen in the scalp. The man was indifferent as regards the condition of 
the skin, and had been referred to me by the resident physician of the 
dispensary, to whom he had come for relief of his dyspepsia. 
I saw the patient ten days later, in the mean time a pepsin mixture 
having been prescribed ; the patches, even after so short an interval, 
seemed a trifle larger, and the excessive surrounding pigmentation re- 
mained remarkably conspicuous. The patient was not seen again until 
one year ago, and then only accidentally. The whole surface was an un- 
natural white. To one unacquainted with the patient his appearance 
would probably have excited no further comment than that he was just 
recovering from a severe illness which had produced profound aneemia. 
It resembled the paleness seen in the last stages of phthisis and albumi- 
nuria. To a close observer, however, the whiteness could be seen to be 
of a different character from that in the diseases referred to. . It was 
more of a dead, marble-like whiteness. There were two small patches of 
pigmentation on the cheeks, which were evidently traces of the confluent 
pigmented borders of the vitiligo spots. The man considered these the 
last vestiges of the disease. As large areas of the skin became white 
from the running together of the vitiligo patches, the islets of pigmen- 
tation-fragmentary portions of the confluent pigmented borders-were 
viewed as the disease, and the whiteness as returning natural skin. The 
patient was aware, however, that his skin was now much paler than before 
the disease began, and what is still more to the point, in answer to ques- 
tions, stated that the skin, so far as the paleness was concerned, was unin- 
fluenced by exposure to the sun, the same as he had noticed in regard to 3 
the individual patches before. This was the case. The patient followed 
the same occupation, and, although it was summer, and he had had the 
usual amount of exposure, the paleness of the skin was unaffected and 
presented the unnatural appearance described above. 
Several months ago I sent for the patient, and a glance showed the 
same condition as had been noted when last under observation, except 
that the few islets of pigmentation referred to had disappeared and given 
place to the unnatural paleness of vitiligo. The color of the hair had 
undergone no appreciable change. A thorough examination of the whole 
surface showed that on parts of the trunk the skin exhibited a tendency to 
a return of the natural color. The patient's general condition was about 
the same, dyspepsia being his sole complaint. THE MEDICAL NEWS, 
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