Vitiligo
Vitiligo is a chronic autoimmune condition in which CD8+ T cells destroy pigment-producing melanocytes, causing patchy skin depigmentation, per the international Vitiligo Task Force management framework.
Symptoms
Flat, milky-white patches with well-defined borders, most often on the hands, face, around body openings, and skin folds; new trauma to the skin can trigger new patches in the same area (Koebner phenomenon).
Causes and risk
An autoimmune attack on melanocytes, often alongside other autoimmune conditions -- thyroid disease, type 1 diabetes, alopecia areata, and pernicious anemia are all more common in people with vitiligo, per current immunology research.
How it is evaluated
Diagnosis is clinical, often aided by a Wood's lamp exam; because of the autoimmune overlap, thyroid antibody screening is commonly recommended, and biopsy is reserved for unclear cases.
Treatment
Topical corticosteroids and calcineurin inhibitors are first-line for limited disease. Topical ruxolitinib is FDA-approved for ages 12 and up (up to 10% body surface area), and narrow-band UVB or excimer phototherapy is standard for more widespread disease, per the Vitiligo Task Force algorithm and pediatric expert recommendations.
When to seek care
Rapidly spreading or newly active patches warrant prompt evaluation, since early intervention improves the odds of halting progression -- as does significant psychological distress, which is itself a recognized marker of disease severity.