What criteria should I use to decide when to refer a patient with vitiligo to a dermatologist?

Criteria for referral of a patient with vitiligo to a dermatologist:

• Refer patients if the diagnosis of vitiligo is uncertain or atypical, requiring specialist assessment.
• Refer if the vitiligo is extensive, rapidly progressing, or causing significant psychological or social distress to the patient.
• Refer if the patient requests specialist advice on treatment options, including advanced therapies or management of difficult-to-treat areas such as the face, hands, or genitalia.
• Refer if there is suspicion of associated autoimmune or other dermatological conditions requiring specialist input.
• Consider referral if initial management in primary care has not controlled the condition satisfactorily or if the patient experiences adverse effects from treatments.

These criteria align with general principles for dermatology referral in skin conditions where diagnosis, severity, impact on quality of life, or treatment complexity warrant specialist input, as seen in NICE guidelines for other skin diseases such as atopic eczema and psoriasis ²,³.