Vitiligo is an autoimmune condition in which the immune system destroys pigment cells, leaving well-defined white patches on the skin. It is not contagious, often begins before age 30, and is linked with thyroid disease and other autoimmune conditions.
Key symptoms
- White patches on the face, hands, around the mouth, eyes or genitals
- Patches that slowly spread or appear at sites of skin injury
- White hair in affected areas
- Sunburn of the white patches and distress about appearance
What you find on exam
- Chalk-white, well-defined patches with normal skin texture
- Usually symmetric on both sides of the body
- Wood lamp: bright blue-white glow in depigmented areas
- White hairs, confetti-like spots or new patches at scratch sites (active disease)
- Signs of thyroid disease
Tests
- Diagnosis is clinical, helped by the Wood lamp
- TSH and thyroid antibodies for autoimmune thyroid disease
- Other tests by symptoms: glucose, vitamin B12
- Biopsy only if the diagnosis is unclear
Treatment basics
- Topical corticosteroids for limited patches
- Topical tacrolimus or pimecrolimus for the face and skin folds
- Ruxolitinib cream for nonsegmental vitiligo
- Narrowband UVB phototherapy for wider disease
- Sun protection, cosmetic camouflage and emotional support
Red flags
- Rapid spread or many new patches (active disease)
- Fatigue, weight change or other signs of autoimmune disease
- Pale patches that are scaly, numb or not fully white, which suggest another diagnosis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.