By Gary M. White, MD
Segmental vitiligo (SV) is a less common variant of vitiligo in which a white depigmented patch occurs in only one segment of the body.
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.
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.
Courtesy Michael O. Murphy, MD
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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