Vitiligo: what it is and how to recognise it

By Cristiano Antonino On Sep 16, 2022

Vitiligo is a non-contagious skin disease that affects melanocytes, the cells responsible for the production of melanin

What is vitiligo?

Vitiligo is a skin disorder characterised by the appearance of characteristic white patches due to damage to the cells responsible for the formation of melanin, the pigment responsible for the colour of our skin.

How widespread is vitiligo and who does it affect?

Vitiligo affects 0.5-2% of the general population, with no significant difference between the sexes.

It can occur at any age although in 95% of cases it appears before the age of 40, often following major psycho-emotional events, skin traumas or burns.

In particular, in 50% of cases it occurs in paediatric age, with a higher incidence in children aged 4-8 years.

What are the causes and triggers?

The presence of a positive family history for vitiligo in 30-40% of patients highlights the existence of a genetic predisposition for the onset of this disease.

Numerous scientific evidences have demonstrated the role of an autoimmune reaction in the pathogenesis of vitiligo, highlighting the presence of autoantibodies directed against melanocytes, the cells responsible for melanin production.

This hypothesis is also supported by the frequent findings of other autoimmune diseases (Hashimoto’s thyroiditis, diabetes mellitus, alopecia areata, pernicious anaemia, Sutton’s nevus) in vitiligo patients.

This is why periodic thyroid function screening and autoantibody screening is recommended at the time of diagnosis to rule out other possibly associated autoimmune diseases.

Vitiligo, how to recognise it?

The characteristic lesion is a roundish or oval-shaped white patch with an irregular border.

The extension of the patch is centrifugal, with a tendency to merge with other surrounding patches.

The hairs within the patch are achromic, i.e. lacking pigment.

The most frequently affected sites are the elbows, knees, tibial crests, back of the hands and feet, areas around the eyes and mouth, and inguinal and axillary folds.

In the presence of multiple lesions, a symmetrical and bilateral distribution is common.

Characteristic of vitiligo is also the appearance of patches in areas subject to trauma of various kinds (Koebner’s phenomenon).

Scalp involvement is presented by the presence of a lock of white hair (leucotrichia).

How is it diagnosed?

The diagnosis is clinical and is based on the characteristic clinical features.

Examination of the affected skin with a Wood’s lamp highlights the contrast between the normal skin and the lesional skin, which emits a milky-white fluorescence.

For the diagnosis, post-inflammatory hypopigmentation (history of previous inflammatory lesions), tinea versicolor (mild desquamation fluorescing under Wood’s light), pityriasis alba (mild desquamation and blurred margins) and achromic nevus (congenital lesion) must be excluded.

What is the clinical course like?

Like all autoimmune diseases the clinical course is unpredictable.

Usually the progression is slow although sudden worsening may occur due to precipitating causes of various kinds, which may range from psychological stress, such as bereavement or job loss, or physical stress.

In a small percentage of cases, spontaneous improvement may occur, with repigmentation of the spots in the absence of treatment.

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