160 Vitiligo
Salient features
Examination
• Hypopigmented patches (Fig. 160.1) that are distributed symmetrically; sometimes the border may be hyperpigmented. The distribution often includes wrists, axillae, perioral, periorbital and anogenital skin
• White hairs in the vitiliginous area
• Some spontaneous re-pigmentation in the sun exposed regions (in a third of cases).
Note: Scratching when the disease is active may induce lesions along the scratch marks; this is termed isomorphic response or Koebner’s phenomenon. It is also seen in response to the friction or pressure resulting from such common activities as brushing hair, drying skin with a towel and wearing a belt or watch.
Diagnosis
This patient has vitiligo (lesion), which is of autoimmune origin (aetiology) and can be cosmetically distressing to the patient (functional status).
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