DR2.1 | Vitiligo Diagnosis and Treatment Planning — Summary & Reflection

KEY TAKEAWAYS

Vitiligo is a common autoimmune pigmentary disorder in which CD8+ cytotoxic T-cells destroy melanocytes, producing sharply defined, milky-white DEPIGMENTED (not merely hypopigmented) macules, often with leukotrichia and a positive Koebner phenomenon, classified as non-segmental (commonest, progressive, autoimmune-associated) or segmental (early-onset, rapidly stable). Diagnosis is clinical: inspect colour and borders, test sensation (normal in vitiligo), and use the Wood's lamp, which shows bright blue-white accentuation. The critical differential — especially in India — is leprosy, which is hypopigmented AND anaesthetic; sensation must be tested on every pale patch. Other differentials include pityriasis versicolor (scaly, KOH-positive, golden-yellow fluorescence), pityriasis alba, nevus depigmentosus, post-inflammatory hypopigmentation, and chemical leukoderma. Treatment is stratified by extent and stability: topical corticosteroids or calcineurin inhibitors for limited disease, narrowband UVB for extensive active disease, surgical grafting only for disease stable for at least one year (IADVL), and depigmentation for very extensive disease. Counselling on chronicity, sun protection, autoimmune screening, and psychosocial impact is essential, including correcting the harmful misconception that vitiligo is leprosy.

REFLECT

Recall the fear in our hook — a family convinced that white patches meant leprosy and the social ruin that word carries — and consider how much harm a careless or a careful examination can each do. Reflect on the discipline of testing sensation on every pale patch, not as a tick-box but as the one habit that prevents you from either missing a treatable infection or inflicting unwarranted stigma. Think about how you would counsel a young person newly diagnosed with vitiligo: how you would explain its autoimmune, non-contagious nature, set realistic expectations about repigmentation, protect their depigmented skin from the sun, and attend to the psychological weight they carry. How will you make the three-step routine — look, test sensation, use the lamp — an automatic reflex for every patch you ever examine?