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The different types of vitiligo

Vitiligo is a skin disease that results in the appearance of white patches due to the disappearance of melanocytes, the cells responsible for skin pigmentation. This condition affects approximately 0.5 to 2% of the world's population, regardless of age, sex, or origin.
There are several forms of vitiligo, which differ in their distribution, progression and response to treatment.

Generalized (non-segmental) vitiligo

This is the most common form, accounting for approximately 80 to 90% of cases. The spots appear symmetrically on both sides of the body, for example, on both hands, both knees, or around both eyes. Its progression is gradual and unpredictable, with phases of spread and sometimes periods of stability. Several subtypes are distinguished: vitiligo vulgaris, with spots scattered over different areas of the body; acrofacial vitiligo, which mainly affects the face and extremities; and vitiligo universalis, which extends to almost the entire body.

Segmental vitiligo

This form manifests as localized patches on one side of the body, for example, on an arm, a leg, or half of the face. It often begins earlier, sometimes in childhood or adolescence, and its onset is generally sudden. Unlike generalized vitiligo, it tends to stabilize after one or two years. It sometimes responds differently to treatments, with a better chance of repigmentation after phototherapy.

Focal or localized vitiligo

It results in the presence of a few isolated spots, without symmetrical distribution and without rapid spread. Its evolution is uncertain: it can remain stable for years or gradually evolve into generalized vitiligo.

Mixed vitiligo

It combines segmental and generalized lesions in the same person. This form is more complex to manage because the two behaviors coexist and evolve differently.

The particular forms

Some variants have specific clinical features. Trichrome vitiligo is characterized by depigmented areas surrounded by a lighter intermediate halo, followed by normal skin. Quadrichrome vitiligo has four shades of pigmentation, while the rarer pentachrome vitiligo adds a dark brown area. There is also mucosal vitiligo, which affects the lips or genitals, and punctate vitiligo, which appears as small, scattered, round white spots.

In summary

Vitiligo is not a uniform disease: there are several forms, ranging from a few isolated spots to almost complete depigmentation of the body. Identifying the type of vitiligo allows the dermatologist to tailor treatment and better inform the patient about the likely progression of their disease.