Vitiligo — Clinical Case (Wikimedia Commons)

Diagnosis: Vitiligo

The Baloch or Baluch are a Western Iranic ethnic group native to the Balochistan region of South and Western Asia encompassing the countries of Pakistan, Iran, and Afghanistan.. Clinical photograph sourced from Wikimedia Commons (CC BY-SA 4.0). Attribution: Mostafameraji.

Clinical Presentation

Well-demarcated, chalk-white macules and patches. Predilection for periorificial areas (mouth, eyes, nostrils), hands, wrists, and genitalia. Enhanced visualization under Wood's lamp. Segmental variant follows dermatomal distribution.

Clinical History

May follow physical trauma (Koebner phenomenon), sunburn, or emotional stress. Family history of vitiligo or autoimmune disease. Screen for thyroid function, diabetes, and other autoimmune conditions. Significant psychosocial impact.

Treatment

Topical: potent corticosteroids (limited courses), calcineurin inhibitors (face/neck). Phototherapy: NB-UVB (first-line for widespread). Topical ruxolitinib (FDA-approved JAK inhibitor). Surgical: melanocyte transplantation for stable segmental vitiligo.

Differential Diagnosis

Pityriasis alba, Tinea versicolor, Post-inflammatory hypopigmentation, Chemical leukoderma, Piebaldism, Idiopathic guttate hypomelanosis

Key Learnings

Ruxolitinib 1.5% cream is the first FDA-approved treatment specifically for vitiligo (2022). NB-UVB requires 6-12 months for response. Repigmentation starts perifollicularly. Screen for associated autoimmune conditions annually.

Tags: vitiligo, depigmentation, autoimmune, melanocyte