While vitiligo is usually idiopathic, some cases are caused by chemicals. If occupational exposure to p-tert-butylphenol (ptBP) leads to vitiligo, the legal requirements for occupational disease Nr. 1314 can be fulfilled in Germany. Chemicals of similar structure can induce local and more widespread symmetrical depigmentation with genital involvement, making the differential diagnosis more complicated. Occupationally caused depigmentation from other chemicals can also be treated according to § 9 sec. 2 of the occupational disease regulations.Some substances can cause leukoderma only in animals; others in animals and humans; in some cases systemic vitiligo-like changes develop. The effects on human skin cannot always be predicted from the structural analogies of the involved chemicals.Based on a case of occupational exposure to butyl hydroxytoluene with possible induction of vitiligo, a careful updated literature analysis of substances inducing depigmentation is presented.The literature contains discrepancies in the evidence for the ability of some substances-especially BHT-to cause vitiligo. A more exact analysis indicates that BHT does not cause vitiligo or leukoderma.
