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Vitiligo

Vitiligo is a chronic patchy depigmenting skin condition due to T-cell-mediated melanocyte destruction.

Suggested approach to vitiligo osce station

Describing lesions

  • Areas of depigmentation
    • ‘There are multiple well-demarcated patches of depigmentation in a generalised distribution.’
    • ‘They range in size from 1-4cm and have irregular borders.’
    • ‘These lesions are flat and there are no secondary features.’
    • ‘These lesions are consistent with vitiligo.’

Differential diagnosis

  • Tinea versicolor
  • Post-inflammatory hypopigmentation
  • Pityriasis alba
  • Scarring
  • Tuberculoid leprosy

Associations

  • Other autoimmune conditions (e.g. thyroid disease, pernicious anaemia, diabetes, Addison’s disease)
  • 20% of cases are familial 
  • Lesions may be triggered by stress, skin trauma or exposure to chemicals

Management

  • General: avoid sun and use strong sun cream (sun-exposed areas will not tan but will burn), avoid skin trauma
  • Screen for other autoimmune diseases
    • Thyroid disease
    • Pernicious anaemia
    • Diabetes
    • Addison’s disease
  • Cosmetic camouflage creams
  • Topical corticosteroids (e.g. clobetasol, mometasone)
  • Topical calcineurin inhibitors (e.g. tacrolimus)
  • Phototherapy
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