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Vitiligo – Information for GPs

Definition

Vitiligo is an acquired condition with complete loss of skin pigment resulting in discrete white patches. For images click here

If affects about 1% of the world population and any part of the body can be affected.

Exclude Red Flag Symptoms

Consider pityriasis alba (hypopigmented patches on the face in childhood and adolescence).

Leprosy (thickened, hypopigmented anaesthetic patches of skin).

Management

Sun protection advice

  • Is essential
  • The white skin will not tan but will burn
  • If surrounding skin tans the white patches will be more apparent

Cosmetic camouflage

  • Very useful as no treatments are very successful in reversing the depigmentation
  • Available from Changing Faces

Potent or very potent topical steroids

  • Mometasone fuorate 0.1% as cream or ointment - Elocon® (potent)
  • Clobetasol Propionate 0.05% as cream or ointment - Dermovate® (very potent)
  • May be used for a trial period of up to 2 months
  • Be aware of problems with steroid side effects

Refer to Dermatology for consideration of other treatments if patient distressed by condition

  • Calcinuerin inhibitors
  • Narrowband UVB
  • Laser treatment
  • PUVA
  • Depigmentation of normal skin if very extensive

Investigations prior to referral

Associated with other autoimmune diseases so exclude diabetes, pernicious anaemia, thyroid disease, Addison’s disease and alopecia areata with blood tests if appropriate

Information to include in referral letter

  • Site and extent of white patches
  • Photograph is desirable
  • How long since problem began
  • Any treatments tried already
  • Relevant past medical / surgical history
  • Current regular medication
  • BMI / Smoking status

Patient information leaflets

Patient Information Leaflets are available from the British Association of Dermatologists or patient.co.uk. Patient information is also available from the Vitiligo Society

References

Excellent clear information and lots of images available from Primary Care Dermatology Society. Useful information also available on dermnet website.

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