GPAtlas🧭 When to suspect
Suspect vitiligo when a patient describes the gradual appearance of well-demarcated, milky- or chalky-white, completely depigmented patches, often first noticed on the face, hands or in skin folds. The depigmentation is uniform and total (unlike the partial fading of post-inflammatory hypopigmentation), with no scale, itch or surface change.
The common form – non-segmental vitiligo – is an acquired autoimmune condition. It is usually symmetrical, favours periorificial skin (around the eyes and mouth), the backs of the hands, fingers, wrists, elbows, knees and genitalia, and tends to evolve in waves over years. New patches appearing at sites of friction or trauma (the Koebner phenomenon) point to active disease.
Raise suspicion further in anyone with a personal or family history of autoimmune disease – autoimmune thyroid disease (the commonest association), type 1 diabetes, pernicious anaemia, Addison's disease or alopecia areata.
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🧠 Clinical pearl – decide the type before you treat Segmental vitiligo is the pattern to recognise: unilateral, respecting the midline, appearing in childhood or early adulthood, spreading quickly for a few months and then stabilising. It has a weaker autoimmune link, responds poorly to creams and light therapy, but – once stable for around 12 months – is the best candidate for surgical (melanocyte) grafting. Calling it correctly changes both the prognosis you give and the referral you make. |
Source: British Association of Dermatologists 2021 · DermNet
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