SEGMENTAL VITILIGO

By Gary M. White, MD

Segmental vitiligo


Segmental vitiligo (SV) is a less common variant of vitiligo in which a white depigmented patch occurs in only one segment of the body.

Clinical

Depigmented macules and patches in a segment, dermatomal or quasi-dermatomal distribution is seen. As noted above, the average age of onset in one study was 18.5 years of age [Ann Dermatol. 2014 Feb; 26(1): 61–65]. 65.5% had segmental facial involvement. 21% showed extensive involvement of two segments or the trunk.

COMPARISON OF SEGMENTAL WITH CLASSIC VITILIGO

Segmental Vitiligo

Classic Vitiligo

Treatment

Segmental vitiligo often responds poorly to treatment. Disease duration > 12 months, poliosis and multiple areas of involvement are associated with treatment-resistant cases.

Combination therapy with 308-nm excimer laser, topical tacrolimus, and short-term systemic corticosteroids has been advocated [J Am Acad Dermatol. 2015 Jul;73(1):76-82].

The use of non-cultured cellular grafting for SV can have excellent results [JAAD 2016;75;564]. In that process, ultra-thin split-skin grafts are taken from the gluteal region under local anesthesia and processed to achieve a hyaluronic acid-thickened cellular suspension. The recipient site is ablated with a CO2 laser and the denuded skin is this suspension is applied. Targeted phototherapy may be added at the second month if poor repigmentation is observed.

Additional Pictures

Segmental vitiligo

Courtesy Michael O. Murphy, MD
Segmental Vitiligo

References

A patient with segmental vitiligo on one side and segmental vitiligo on the other is illustrated. Segmental vitiligo with segmental morphea: An autoimmune link?. Indian Dermatol Online J 2014;5, Suppl S1:23-5

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