Clinical Presentation & Appearance
Vitiligo lesions typically initiate as small macules (flat spots < 1 cm) that gradually enlarge and coalesce into expansive patches. The affected skin feels entirely normal in texture, elasticity, and sensation—there is no peeling, redness, scaling, or surface change unless secondary dermatitis or sun damage is present.
Primary Manifestations:
- Chalky / Milk-White Depigmentation: Contrast is particularly noticeable in medium and darker skin tones (Fitzpatrick skin types III to VI). Under direct sunlight or ultraviolet illumination, the borders appear distinct and sharply demarcated.
- Predilection Sites: Vitiligo commonly manifests around body orifices (perioral, periocular), dorsal surfaces of the hands and fingers, wrists, elbows, knees, feet, ankles, and genital zones.
- Poliosis (Hair Whitening): When vitiligo invades hair-bearing skin, melanocytes within hair follicles can be destroyed, resulting in premature white or silver hair strands on the scalp, eyebrows, eyelashes, or beard.
- Mucosal Depigmentation: Loss of pigmentation can affect mucosal linings, including the inner lips, gingiva, and genital mucous membranes.
Variations in Lesion Appearance
- Trichrome Vitiligo: Shows three distinct color zones: normal skin, an intermediate hypopigmented light-brown border, and a central amelanotic white core. This reflects active disease expansion.
- Confetti-like Macules: Tiny, scattered pale spots often appearing around evolving larger patches, indicating rapidly progressive vitiligo.
- Marginal Erythema: Occasionally, the active leading edge of a patch exhibits a slightly raised red, inflamed border (inflammatory vitiligo).
Frequently Asked Questions
Does vitiligo cause physical itching or pain?
Vitiligo itself rarely causes physical pain. However, active evolving borders occasionally exhibit mild pruritus (itching). The white skin is also prone to severe, painful sunburns if unprotected.
How can I tell if my vitiligo is active and spreading?
Indicators of active disease include ill-defined borders, confetti-like hypopigmented macules around existing patches, the Koebner phenomenon (patches developing at scratch sites), and rapid appearance of new spots.