Vitiligo
Also called acquired depigmentation
Autoimmune destruction of melanocytes: sharply demarcated, completely depigmented (chalk-white) macules and patches, often periorificial and acral, enhancing under Wood lamp.
High contrast against deeply pigmented skin
How it looks
Sharply demarcated depigmented macules and patches symmetrically involving the dorsal hands and periorbital skin, chalk-white without scale or surface change.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
Contrast, and therefore psychosocial impact, scales with baseline pigmentation; in very fair skin vitiligo may only be visible under Wood lamp. Same disease, radically different lived experience.
Symptoms & course
- Asymptomatic, the burden is visible difference, which can be profound
- Depigmented skin sunburns easily
Diagnostic approach
- Wood lamp: depigmentation fluoresces bright blue-white
- Consider thyroid screening, autoimmune association
Differential, and how to separate them
- Pityriasis rosea
Favours it: Scaly, transient, erythematous phase
Against it: Vitiligo has zero surface change and total pigment loss
- Tinea corporis
Favours it: Scale and an advancing border (tinea versicolor is the closer mimic)
Against it: Vitiligo is smooth, non-scaly, and Wood-lamp bright white
Management principles
- Topical corticosteroids or calcineurin inhibitors for limited disease
- Phototherapy for widespread disease
- Photoprotection of depigmented skin; camouflage support matters
Clinical pearl: Depigmented (white) versus hypopigmented (lighter) is decided by the Wood lamp, and that decision separates diagnoses.
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