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Clinical Summary

Vitiligo is an acquired loss of pigmentation commonly involving the face, body folds, and backs of the hands. There is a positive family history in 30%. Initially the disease is limited, but it then slowly progresses over years. Vitiligo is secondary to the absence of epidermal melanocytes, which may be due to an autoimmune phenomenon. Approximately half of these cases begin in patients less than 20 years of age.

Management and Disposition

Refer patients to a dermatologist for further workup and long-term treatment.


  1. Vitiligo can occur at sites of trauma (Koebner phenomenon).

  2. Wood lamp examination helps identify hypopigmented areas in patients with light complexions.

  3. Tinea versicolor, in contrast, has a scale and positive KOH preparation.

FIGURE 13.128

Vitiligo. Well-defined, hypopigmented areas are characteristic. (Photo contributor: James J. Nordlund, MD.)

FIGURE 13.129

Vitiligo. Almost complete depigmentation of the hands. (Used with permission from Fauci AS, Braunwald E, Kasper DL, et al. Harrison’s Principles of Internal Medicine. 17th ed. New York, NY: McGraw Hill; 2008: 312.)

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