Vitiligo
Vitiligo is a common acquired autoimmune condition in which destruction of melanocytes produces well-demarcated, completely depigmented macules and patches without scale, most often on the extensor surfaces, hands, face, and periorificial skin. Diagnosis is clinical, supported by Wood's lamp examination showing bright, sharply delineated fluorescence, and first-line treatment is a topical high-potency corticosteroid or a topical calcineurin inhibitor such as tacrolimus, with phototherapy for widespread disease.
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What this article covers
- Overview
Definition: vitiligo is a common acquired autoimmune condition in which loss or destruction of melanocytes produces patchy, well-demarcated depigmentation of the skin.
- Epidemiology
Peak incidence: most often diagnosed in patients in their 20s and 30s, though it can present at any age.
- Risk factors
Personal or family history of autoimmune disease: vitiligo clusters with other autoimmune conditions, and a family history raises risk.
- Pathophysiology
Autoimmune melanocyte destruction: vitiligo results from an autoimmune process that destroys or eliminates melanocytes, the pigment-producing cells of the epidermis.
- Clinical features
Diagnostic morphology: completely depigmented, well-demarcated, symmetric macules or patches with no scale and no signs of inflammation define the clinical picture.
- Differential diagnosis
Tinea versicolor: hypopigmented patches with a fine surface scale and a positive potassium hydroxide preparation showing hyphae and yeast, unlike the scale-free, KOH-negative macules of vitiligo.
- Diagnosis
First, establish the diagnosis clinically from the appearance of sharply demarcated, fully depigmented, scale-free macules on typical sites, which is sufficient without biopsy in most patients.
- Management
First-line, for limited or stable disease, apply a topical high-potency corticosteroid or a topical calcineurin inhibitor: tacrolimus ointment 0.1% (1 mg per g) in adults, or 0.03% (0.3 mg per g) in…
- Complications
Psychosocial distress: vitiligo is a significant cause of social stigmatization and low self-esteem, given its visible, symmetric involvement of exposed skin.
- Prognosis
Chronic and unpredictable course: vitiligo can remain stable for long periods or progress gradually, and disease behavior varies considerably between patients.
- Prevention
Sun protection over depigmented skin: consistent sunscreen use prevents sunburn in areas that have lost their natural melanin protection.
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