Background:
Vitiligo is a relatively common acquired pigmentation disorder that can cause significant
psychological stress and stigmatism.
Objective:
This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and
management of vitiligo.
Methods:
A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included metaanalyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the
English literature. The information retrieved from the above search was used in the compilation of the present article. The
information retrieved from the above search was used in the compilation of the present article.
Results:
Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic,
immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically
presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions
tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by
the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no
active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred
for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the
mainstays of treatment.
Conclusion:
The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As
such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease
onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment of
choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia,
intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not
respond to treatment with topical corticosteroids and calcineurin inhibitors.
