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Vitiligo — SCE Dermatology MCQ

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HardInflammatory DermatosesVitiligoSCE Dermatology

A 35-year-old woman has widespread vitiligo. She has depigmented patches covering approximately 70% BSA. Her pigmented areas are scattered and she finds the contrast distressing. What treatment approach is most appropriate for very extensive vitiligo (>50% BSA)?

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Correct answer: D — Consider specialist irreversible depigmentation only after detailed counselling

The best answer is “Consider specialist irreversible depigmentation only after detailed counselling”. Vitiligo management includes camouflage, photoprotection, topical therapy, phototherapy and psychological support; irreversible depigmentation is reserved for exceptional extensive disease after specialist counselling. The alternatives “Oral corticosteroids, within an appropriate UK pathway”, “NB-UVB phototherapy to all areas, after clinicopathological correlation”, “Surgical melanocyte transplantation, after specialist assessment”, “Potent topical corticosteroid to all depigmented areas” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: BAD vitiligo guideline 2021: https://academic.oup.com/bjd/article/186/1/18/6593593