Vitiligo: An Update on Pathophysiology and Treatment Options

Reinhart Speeckaert; Nanja van Geel

Disclosures

Am J Clin Dermatol. 2017;18(6):733-744. 

In This Article

Types of Vitiligo and Differential Diagnoses

Non-segmental vitiligo (±85 to 90%) is far more common than segmental vitiligo (±10%).[6] Non-segmental vitiligo is characterized by the development of depigmentations on both sides of the body, whereas segmental vitiligo is typically limited to one side of the body usually not crossing the midline. In segmental vitiligo, typical distribution patterns in the face and trunk have been described, which aid in the differential diagnosis.[7,8] Early recognition of the subtype of vitiligo is essential as the evolution and treatment are markedly different. In most patients, nonsegmental vitiligo has a chronic course with a continuing chance of progression throughout life. In contrast, segmental vitiligo is characterized by a rapid disease onset (often in a few days to weeks). The disease usually stabilizes after 1–2 years and other areas of the body are typically not at risk. However, a form of mixed vitiligo has been described in a small subset of patients.[9] This type involves a combination of segmental vitiligo and nonsegmental vitiligo in the same patient. Focal vitiligo is a localized small depigmented area that remains isolated. The diagnosis of focal vitiligo is often only retrospectively possible as it progresses in half of the cases to non-segmental vitiligo within 2 years after disease onset.[10]

The main differential diagnoses for vitiligo are other depigmentary and hypopigmentary disorders such as pityriasis versicolor, pityriasis alba, melasma, halo naevus, naevus hypopigmentosus, naevus anemicus, lichen striatus, progressive macular hypopigmentation, and hypopigmented mycosis fungoides. A rare but important differential diagnosis is the spontaneous occurrence of depigmentations in patients with melanoma. In a series of photographs, vitiligo experts were not able to differentiate melanoma-associated leukoderma clinically from vitiligo.[11] This illustrates that an increased awareness for suspected pigmented lesions may be warranted in patients with vitiligo, especially in patients with disease onset at an older age.

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