#vitiligo - white skin spots: symptoms, diagnosis and treatment.

And to complete our series on the most common white patches on the skin (pityriasis alba and pityriasis versicolor were aproached in previous posts), it's time for vitiligo. Vitiligo is a relatively common autoimmune hereditary disease, that causes complete depigmentation of the skin , ie , the patches of vitiligo are completely white (unlike p. alba and mycoses). By having the same origin, vitiligo may be associated with other autoimmune diseases such as type 1 diabetes, hypo / hyperthyroidism, lupus, etc. The white spots may appear in childhood and tend to be symmetric, ie appear in the same areas on both sides of the body. Clinical diagnosis should be confirmed by biopsy .
The disease is unpredictable , ie , it can spread rapidly through the body or can totally regress spontaneously. Emotional factors such as stress or depression can worsen the disease. Drug treatment will depend on the type of lesions (single or multiple, small or large) and the stage of the disease. Sun protection is essential as the white areas may present with severe burns. 
The most commonly used treatments are :
For localized spots : ointments based on potent corticosteroids or, optionally, ointment based on immunomodulators (tacrolimus, pimecrolimus);

To widespread lesions : phototherapy under strict medical supervision. In this treatment, substances that leave skin more sensitive to the sun, in the form of creams or lotions, are applied on the patches and then the patient is asked to expose to the sun. Again I emphasize that this procedure should be performed with caution under the guidance of a dermatologist because of the risk of severe burns. When performed correctly, phototherapy can promote and accelerate the skin repigmentation.

For the most serious cases affecting most of the body, depigmentation or full skin whitening can be the best option.