6.3.4 Vitiligo

Grading & Level of Importance: B




Acquired circumscribed depigmentation.

Aetiology & Pathogenesis

Autoimmune process affecting, finally leading to destruction of melanocytes. Association with atopy, autoimmune thyroid disease.

Signs & Symptoms

Circumscribed small (confetti-like) macules which may also be confluent to produce larger patches, usually symmetrical; complete depigmentation under Wood’s light. Not itchy.


Favours face, hands, ano-genital region, peri-umbilical area, but any location possible. Sometimes generalized. May affect hair (poliosis).


Segmental (affecting only one side of the body).

Non-segmental (affects both sides of the body). Acral and central type.

Laboratory & other workups

Screen for other autoimunne disseases, if appropriate.


Absent epidermal pigment, lymphocytic inflammatory infiltrate in early phase, destruction of melanocytes in later chronic phase.


Spontaneous resolution possible. Acral sites (hands, feet and ano-genital areas) are often resistant to treatment; facial vitiligo is often more responsive to treatment than other body sites. Treatment response generally declines with the age of the lesion.


Because of lack of biological filter (melanin pigment) increased risk of sunburn, and consequent actinic damage. Often severe dysmorphophobia.


Clinical findings.

Differential diagnosis

Albinism, pityriasis versicolor, naevus anaemicus, naevus depigmentosus, pityriasis alba, dry skin in darker skin types, hypomelanosis pigmentosa, macular form of lichen sclerosus, any cause of post-inflammatory hypopigmentation, other rare, hereditary causes of hypopigmentation (e.g. piebaldism etc.).

Prevention & Therapy

Early treatment.

Topical potent/superpotent corticosteroids; topical calcineurin inhibitors; phototherapy; consider melanocyte-keratinocyte transplants from normally pigmented skin. Consider afamelanotide with UVB photo(chemo)therapy.Cosmetic camouflage with make-up. Bleaching agents for normally pigmented skin if vitiligo widespread.

Topical sunscreens to prevent sun damage.

Counselling/psychological support especially for those with darker skin types, where the psychosocial impact may be severe.

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