Vitiligo is a common, acquired multifactorial skin disease. It is characterised by progressive depigmentation of the epidermis in circumscribed areas, typically without erythema or scaling.
Age of onset is bimodal and involves a major genetic component.
Multiple auto-immune disorders may be associated with vitiligo, most commonly auto-immune thyroiditis.
Management with narrow-band UV-B light and topical immunosuppressants can provide significant improvement in most cases.
When repigmentation occurs, it typically occurs in a perifollicular pattern.
Vitiligo may have a significant psychological impact and clinicians should screen for this.
Vitiligo is an acquired loss of melanocytes in circumscribed areas of the epidermis, resulting in complete depigmentation of affected skin. The extent of the disease ranges from limited, focal disease to almost complete (universal) pigment loss.
History and exam
Key diagnostic factors
- presence of risk factors
- acral and periorificial depigmentation
- perianal and genital depigmentation
- recent cutaneous trauma
- localised sunburn pain
- enhancement and fluorescence with UV-A exposure
- halo naevus
- universal depigmentation
- age <30 years
- family history of vitiligo
- autoimmune disease
- chemical contact
1st investigations to order
- clinical diagnosis
Investigations to consider
- Wood’s lamp examination
- skin biopsy
segmental vitiligo or limited vitiligo
widespread vitiligo (more than 3% body surface area)
- Waardenburg's syndrome
- Tuberous sclerosis
- British Association of Dermatologists guidelines for the management of people with vitiligo 2021
- Guidelines for the management of vitiligo
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