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ukmla 2026

Vitiligo

Autoimmune depigmenting disorder — well-demarcated chalk-white macules from melanocyte destruction, associated with other autoimmune conditions

Review date
reviewed 2026-04-05
Reading time
4 min read
Author
Dr Kola Tytler MBBS CertHE MBA MSt MRCGP
Dermatologyless-commonchronic
On this page
Condition details
Dermatology
less-common
4 min read
reviewed 2026-04-05
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About This Page

This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.

Key points

  • Well-demarcated, chalk-white, completely depigmented macules and patches
  • Autoimmune melanocyte destruction — associated with thyroid disease, T1DM, Addison's, pernicious anaemia
  • Non-segmental (commonest, bilateral) and segmental (unilateral, dermatomal)
  • First-line: potent topical corticosteroid (body) or topical tacrolimus (face)
  • NB-UVB phototherapy for widespread disease. Screen with TFTs

Overview

Vitiligo is an acquired depigmenting disorder from autoimmune melanocyte destruction. Non-segmental (~85-90%) is bilateral, symmetric, progressive. Segmental (~10-15%) is unilateral, dermatomal, more stable. Koebner phenomenon positive. Associated with autoimmune thyroid disease (up to 20%), T1DM, Addison's, pernicious anaemia.

Epidemiology

Affects ~0.5-2% worldwide. No racial/sex predilection. Onset before 20 in ~50%. Family history in ~20-30%.

Clinical Features

Symptoms
Well-demarcated chalk-white patches of COMPLETE depigmentation
Non-segmental: bilateral, symmetric — face, hands, wrists, genitalia
Segmental: unilateral, dermatomal, rapid then stable
Koebner phenomenon at sites of trauma
Significant psychological distress
Signs
Sharply demarcated, completely depigmented patches — enhanced under Wood's lamp
Leucotrichia: white hairs within patches (poorer prognosis for repigmentation)

Investigations

First-line
Clinical diagnosisWood's lamp accentuates depigmentation
TFTsScreen for autoimmune thyroid disease — repeat annually
Second-line
FBC, glucose/HbA1cScreen for pernicious anaemia, T1DM if indicated

Management

BAD Guidelines + NICE CKS
1
General
  • Sun protection — depigmented skin burns easily
  • Camouflage creams (available on NHS)
  • Psychological support — significant QoL impact
2
Topical (limited disease)
  • Potent topical corticosteroid (body): betamethasone 0.1%, 2-month trial
  • Topical tacrolimus 0.1% (face/flexures): steroid-sparing
3
Phototherapy (widespread)
  • NB-UVB: 2-3x/week for 6-12 months. Best evidence-based option
  • Repigmentation starts perifollicularly (from hair follicle melanocytes)

Complications

  • Psychological impact: Depression, anxiety, social stigma
  • Sunburn: Depigmented skin lacks melanin protection
  • Associated autoimmune disease: Thyroid most common
UKMLA Exam Tips
  • 1Vitiligo = COMPLETE depigmentation (chalk-white). Post-inflammatory = INCOMPLETE (lighter)
  • 2Screen for thyroid disease (TFTs) — most common association
  • 3Koebner phenomenon also in psoriasis, lichen planus, warts
  • 4Repigmentation starts PERIFOLLICULARLY — from follicular melanocyte stem cells
  • 5Topical tacrolimus for FACE vitiligo (avoids steroid skin thinning)

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Verified Sources & References

BAD — Vitiligo Guidelines
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