Segmental vitiligo in Adult
Segmental vitiligo is 10 times less common than generalized vitiligo. It typically has an earlier age of onset compared with generalized vitiligo. The majority of cases occur before age 30, from infancy to adulthood. The lesions are usually chalk-white in color with well-demarcated margins. They range in size from millimeters to centimeters. The affected skin is asymptomatic but is more prone to sunburn. There is a higher frequency of leukotrichia (white hair) compared to nonsegmental vitiligo. Segmental vitiligo typically involves a single segment (monosegmental) on only one side of the body. However, rare variants that involve multiple segments (distributed either unilaterally or bilaterally) have been reported. Segmental vitiligo typically evolves over a few months after initial presentation and then remains stable in appearance.
Concomitant occurrence of segmental and generalized vitiligo has been described and is referred to as mixed vitiligo. In such cases, segmental disease usually precedes the generalized form by at least 6 months.
L80 – Vitiligo
403268000 – Segmental vitiligo
Differential Diagnosis & Pitfalls
- – Usually hypopigmented and not depigmented. Usually presents at birth or within the first few months of life. The borders are typically jagged. Not progressive but enlarges in size proportional to body size increase. Leukotrichia is not common.
- – A solitary hypopigmented macule or patch with surrounding small satellite macules, favoring the chest or back. Usually presents at birth. Wood's lamp does not highlight the lesion. Diascopy results in blanching of the surrounding skin, making the borders of the lesion confluent and indistinguishable from surrounding skin.
- Focal – Typically isolated and focal; segmental involvement is not conspicuous.
- – Depigmented macules or patches at the site exposed to depigmenting agents. Generalized depigmented patches may ensue. Obtain a careful occupational and exposure history to rule out this diagnosis, which could mimic vitiligo clinically.