Vitiligo

Vitiligo is an acquired chronic skin disorder characterized by well-defined patchy depigmentation caused by destruction or loss of melanocytes (pigment-producing cells).It affects all ages and skin types but is more noticeable and psychologically distressing in dark-skinned individuals.

The condition is not infectious, not contagious, and not life-threatening, but has major cosmetic and psychosocial impact.

Pathophysiology (Brief)

Main mechanism: Autoimmune destruction of melanocytes

Contributing factors:

• Genetic susceptibility

• Oxidative stress

• Neural factors

• Association with autoimmune diseases

Common associations:

• Thyroid disease

• Type 1 diabetes

• Pernicious anemia

• Alopecia areata

Signs & Symptoms

Typical lesions:

• Milk-white depigmented patches

• Sharply demarcated borders

• Symmetrical distribution

Common sites:

• Face (around mouth and eyes)

• Neck

• Hands and fingers

• Elbows and knees

• Trunk

• Genitals

• Lips and oral mucosa

Other findings:

• Premature greying of hair (poliosis)

• Leukotrichia (white hair in lesions)

• Sunburn easily on affected areas

• Psychological distress (low self-esteem)

Diagnostic Criteria

Clinical diagnosis based on:

• Depigmented patches on face, neck, trunk and extremities

• Mucosal depigmentation (oral or genital areas)

Supporting signs:

• Chalk-white color

• Well-defined margins

• Symmetry

Investigations

Usually clinical diagnosis, but investigations help detect associated disease.

Recommended tests

• Thyroid function tests (TSH)

• Fasting blood glucose

• Full blood count

• Vitamin B12 (if anemia suspected)

Special tests

• Wood’s lamp examination → lesions appear bright white

• Skin biopsy (rarely needed)

Treatment

Non-Pharmacological Treatment

• Patient counselling and reassurance

• Avoid stigma and psychological stress

• Cosmetic camouflage creams

• Avoid skin trauma (Koebner phenomenon)

• Protective clothing

• Psychological support if needed

Sun Protection

• Sunscreen SPF 30+ at 8:00 am and 2:00 pm daily

• Prevents sunburn and reduces contrast between lesions and normal skin

Pharmacological Treatment

Topical therapy

• Betamethasone valerate ointment 0.1% — apply every 12 hours for 2–4 months

Other useful options (specialist level)

• Topical calcineurin inhibitors (face/genitals)

• Phototherapy (NB-UVB)

• Short oral steroids for rapidly spreading disease

Complications

• Sunburn

• Eye inflammation (uveitis – rare)

• Psychosocial distress

• Cosmetic disfigurement

Prevention

No absolute prevention, but progression can be reduced by:

• Early treatment

• Sun protection

• Avoid skin injuries and chemical exposure

• Control associated autoimmune diseases

• Regular follow-up

Patient Counselling (Important)

• Condition is not infectious

• Not caused by poor hygiene

• May repigment partially with treatment

• Treatment takes months

• New patches may still occur