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Dermoscopy of vitiligo

Author: Dr Balachandra Ankad, Professor, Department of Dermatology, S Nijalingappa Medical College, Bagalkot-587103, Karnataka, India; DermNet NZ Editor in Chief Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. October 2019.


What is vitiligo?

Vitiligo is a commonly acquired depigmentation of the skin due to autoimmune destruction of melanocytes. It is characterised by well-circumscribed chalky-white macules and patches. Hairs in the involved skin may be normal or white. 

The incidence of vitiligo is apparently higher in the Indian subcontinent due to its colour contrast and stigma attached to the condition.

Vitiligo is also known as as 'swetha kushta' in India.

What are the clinical features of vitiligo?

The clinical manifestations of vitiligo include depigmented macules and patches on the skin, mucous membranes, and hair. Vitiligo is asymptomatic although some patients complain of itching before the macules appear. White hairs in the involved area are associated with a poor prognosis.

Vitiligo has a tremendous impact on the social life of patients. They often have low self-esteem and are depressed, and hence avoid social gatherings. It is said that ‘vitiligo licks the skin but bites the mind’.

What are the dermoscopic features of vitiligo?

The dermoscopic features of vitiligo include [1]:

  • White structureless areas (absence of pigment network) and reduced pigment network. White structureless areas appear to ‘glow’ due to total loss of melanocytes in the epidermis
  • Perilesional and perifollicular hyperpigmentation and reversed pigment network
  • Starburst pattern, tapioca sago pattern (satellite lesions), micro-koebnerisation, and comet-tail appearance [2]. 

Stable vitiligo is characterised by a sharp border, white structureless areas, reduced pigment network, and perilesional and perifollicular hyperpigmentation, whereas active disease demonstrates a starburst pattern, tapioca sago pattern (satellite lesions), micro-koebnerisation and comet-tail appearance.

What is the dermoscopic differential diagnosis for vitiligo?

The dermoscopic differential diagnosis of vitiligo includes naevus depigmentosus, idiopathic guttate melanosis, pityriasis alba and pityriasis versicolor.

  • The dermoscopy of naevus depigmentosus shows white structureless areas with a faint pigment network in the background. Glow is absent due to the presence of the network. White areas may extend peripherally.
  • Like vitiligo, idiopathic guttate hypomelanosis has a glow on dermoscopy but unlike vitiligo, the white area is clearly demarcated from normal skin. Guttate hypomelanosis has amoeboid (pseudopod-like border), petaloid, feathery and nebuloid (gradually fading border) morphological variants. 
  • The dermoscopy of pityriasis alba shows white structureless areas without a glow, a faint pigment network, and superficial white scales.
  • The dermoscopy of pityriasis versicolor also shows white structureless areas without a glow, pigment network and white scales. Scales are prominent in the skin lines and are separated into lines when the lesion is stretched.

Clinical images of differential diagnoses of vitiligo

What is the histological explanation of the dermoscopic features of vitiligo?

The histology of vitiligo shows a normal epidermis with loss of melanocytes. A normal reticulate pigment network is due to melanocytes in the rete ridges. In vitiligo, destruction of melanocytes results in loss of the pigment network resulting in the dermoscopic glow [3].

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Related information

 

References

  1. Nirmal B, Antonisamy B, Peter CVD, et al. Cross-Sectional Study of Dermatoscopic Findings in Relation to Activity in Vitiligo: BPLeFoSK Criteria for Stability. J Cutan Aesthet Surg. 2019 Jan-Mar;12(1):36–41. doi: 10.4103/JCAS.JCAS_75_18. PubMed PMID: 31057267; PubMed Central PMCID: PMC6484572
  2. Kumar Jha A, Sonthalia S, Lallas A, Chaudhary RKP. Dermoscopy in vitiligo: diagnosis and beyond. Int J Dermatol. 2018 Jan;57(1):50–54. doi:10.1111/ijd.13795. Epub 2017 Oct 26. PubMed PMID: 29076154.
  3. Ezzedine K, Lim HW, Suzuki T, et al. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2012 May;25(3):E1–13. doi: 10.1111/j.1755-148X.2012.00997.x. PubMed PMID: 22417114; PubMed Central PMCID: PMC3511780.

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