Vitiligo — Clinical Case (Wikimedia Commons)

Diagnosis: Vitiligo

Atelier de maquillage correcteur au sein de l'Association Française du Vitiligo. Clinical photograph sourced from Wikimedia Commons (CC BY-SA 4.0). Attribution: L'association française du vitiligo.

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