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Home » Topics A–Z » Dermoscopy of vitiligo
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 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.
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’.
Clinical images of vitiligo
The dermoscopic features of vitiligo include [1]:
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.
White structureless area 'glow' (black stars), perifollicular pigmentation (yellow arrow), reticulate pigmentation (red arrow) and perilesional hyperpigmentation (red star). White structureless area 'glow' (red star) and perifollicular pigmentation White structureless area 'glow' (black stars), perilesional pigmentation (yellow arrows) and satellite lesions (black arrows)Dermoscopy of vitiligo
The dermoscopic differential diagnosis of vitiligo includes naevus depigmentosus, idiopathic guttate melanosis, pityriasis alba and pityriasis versicolor.
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 [3].
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