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Author: Prof. Balachandra Ankad, Dermatologist, S Nijalingappa Medical College, Karnataka, India. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. October 2019.
Vitiligo is a common 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 clinical manifestations of vitiligo include depigmented macules and patches on the skin, mucous membranes, and hair. White hairs in the involved area are associated with a poor prognosis.
Clinical images of vitiligo in skin of colour
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.
Dermoscopy of vitiligo in skin of colour
Clinical images of differential diagnoses 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.
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