Vitiligo is a common, acquired multifactorial skin disease. It is characterized 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 autoimmune disorders may be associated with vitiligo, most commonly autoimmune thyroiditis.
Management with narrowband 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
- acral and periorificial depigmentation
- perianal and genital depigmentation
- recent cutaneous trauma
- localized sunburn pain
- enhancement and fluorescence with UV-A exposure
- halo nevus
- universal depigmentation
- age <30 years
- family history of vitiligo
- autoimmune disease
- chemical contact
1st investigations to order
- clinical diagnosis
Investigations to consider
- Wood lamp exam
- skin biopsy
segmental vitiligo or limited vitiligo
widespread vitiligo (more than 3% body surface area)
- Waardenburg 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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