Snapshot A 19-year-old African American woman presents to her dermatologist for evaluation of white patches on her skin. She reports white patches developing on her hands, face, and chest in the past few months. She has been covering them up with makeup powder but admits to feeling depressed because of the lesions. Her past medical history includes autoimmune thyroid disease. Physical exam reveals multiple sharply demarcated macules and patches of depigmentation. She is started on phototherapy. Introduction Clinical definition autoimmune disease characterized by depigmentation due to loss of epidermal melanocytes Epidemiology demographics onset between 10-30 years of age risk factors family history of vitiligo Pathogenesis exact mechanism is unknown theories include autoimmune attack on melanocytes stress leading to neurogenic factors that affect melanocyte survival reactive oxygen species attack on melanocytes Associated conditions vitamin D deficiency thyroid disease alopecia areata Prognosis chronic disease that waxes and wanes Presentation Symptoms asymptomatic Physical exam depigmented patches (not just lack of a tan or hypopigmentation) sharply demarcated white lesions Wood lamp can highlight these areas lesions will be fluorescent Studies Biopsy rarely needed only done when clinical diagnosis is unclear Histology absence of melanocytes on tissue slide loss of epidermal pigmentation Differential Tinea versicolor Pityriasis alba Treatment Conservative cosmetic camouflage indication for patients who wish to camouflage the vitiligo patches modalities temporary makeup to color skin tattoo bleaching skin to produce uniform color sunscreen indications to protect against sunlight Medical topical treatments indication for localized disease drugs corticosteroids calcineurin inhibitors phototherapy indication for widespread disease used often with topical vitamin D analogs or oral corticosteroids modalities narrowband ultraviolet B psoralen with ultraviolet A oral corticosteroids indications used either alone or with phototherapy Complications Poor quality of life and psychologic burden