Types of Vitiligo
There are several different forms of vitiligo, however there is a lack of consensus in classification and definition.
Classification is simplest to identify in two forms; segmental (SV) and non-segmental (NSV), which is also referred to as vitiligo vulgaris (meaning common vitiligo). A third classification is a combination of SV and NSV.
Note: Classification of vitiligo as well as corresponding sub-classes still vary within the clinical community and is often found to vary from one clinical information source to another. There are many other disorders that can lead to depigmentation of skin including piebaldism, tuberous sclerosis, and Ito's hypomelanosis. Proper diagnosis of vitiligo often includes examination by Wood's lamp (UVA lightsource).
Non-segmental Vitiligo (NSV):
Subtypes of NSV include:
Segmental Vitiligo (SV):
Subtypes of SV include:
- Bi- or Plurisegmental
Focal Vitiligo: (also known as Vitiligo Areata): A few isolated white patches in various body areas. For limited vitiligo without a clear distribution pattern, focal vitiligo is the preferred term. It is thought that focal vitiligo may be a pre-cursor of generalized vitiligo, with more than half of focal vitiligo patients evolving to a generalized form over time. Lee HS, Hann SK. (1998) Bilateral Segmental vitiligo. Ann Dermatol (Seoul) View image of focal vitiligo
Mucosal Vitiligo (MV): Involves depigmentation of the mucous membranes of the oral cavity and genitals. This case of vitiligo is rare or undetected in white individuals. View image of mucosal vitiligo
Acral or Acrofacial Vitiligo: Loss of skin color on tips of fingers and toes, anogenital area, and on face (lips, around eyes etc). This area of skin is especially hard to re-pigment due to the lack of melanocyte reserves. Skin grafts and melanocyte transplantation in combination with UV phototherapy are a viable treatment option. View image of acral vitiligo
Generalized Vitiligo: This is a common term for non-segmental vitiligo, and is characterized by symmetrical distribution generalized over certain areas of the body. Shape of macules is round to oval and can vary in size from a few to several centimeters in diameter. Fingers, hands, and face are often reported as initial spots for onset of vitiligo. The most common form is vitiligo vulgaris. View Image of generalized vitiligo
Vitiligo Univeralis (VU): Complete (or nearly complete) depigmentation of the skin. This is the most extensive and most uncommon form of vitiligo. This form can start as NSV (but SV does not progress to VU). Sufferers of VU often exhibit "breakthrough" repigmentation. Treatment typically centers on depigmenting the breakthrough regions and homogenizing the skintone there.
Variants of Vitiligo include:
Multichrome Vitiligo: A form of vitiligo seen in darker skin types (IV-VI). In this form of vitiligo, areas of depigmentation coexist with hypopigmented areas and with normal color (as in surrounding skin). Various degrees of hypopigmentation can occur leading to multichrome vitiligo.
Vitiligo Minor: Characterized by a homogeneous hypopigmented pattern. This pattern is not unusual in dark-skinned individuals.
Vitiligo may evolve over time and be re-classified as it spreads. Before beginning any treatment regimen, it is important to watch for changes in behavior or pattern of vitiligo. Additionally, monitoring Quality of Life (QoL) is an important, and often overlooked, aspect of care that should be tracked alongside treatment.