What are the different forms of vitiligo?

Segmental vitiligo is the most commonly encountered form of vitiligo . It is characterized by bilateral and often symmetrical hypochromic macules. Non-segmental vitiligo typically begins with the appearance of a single white spot, then progresses in a highly variable manner over time. The lesions generally have an acrofacial distribution, meaning they are primarily found on the face, hands, and feet, or are symmetrically dispersed throughout the body. Non-segmental vitiligo can be further subdivided into several types:

• Mucosal vitiligo.

  Also known as mucosal vitiligo, mucous vitiligo is a specific form of vitiligo that primarily affects the oral mucosa, namely the inside of the cheeks, gums, and lips, and/or genital areas, that is, the vulva, glans, or other external genital areas. It can appear in the context of generalized vitiligo, and be accompanied by other depigmented lesions on the body, or manifest in isolation, without any other visible skin involvement. When mucous vitiligo remains strictly limited to the mucous membranes after a follow-up of at least two years, it is classified as unclassified vitiligo, a category reserved for atypical or localized forms.

• Acrofacial vitiligo.

  Acrofacial vitiligo is characterized by depigmented patches confined to the distal extremities and/or the face. It is primarily present around the edges of the lips and eyes. It can then spread to other parts of the body and be classified as generalized or universal, or remain limited to the face, hands, and feet. The form of vitiligo known as "lip-tip" is a subcategory of the acrofacial type in which the lesions are confined to the lips and the distal tips of the fingers.

• Universal vitiligo.

  Universal vitiligo is an advanced form of the disease where skin depigmentation is almost total, affecting 80 to 90% of the body surface. In this type of vitiligo, the skin's natural color almost entirely disappears, giving way to a uniformly white hue. The hair and other pigmented follicular structures, such as eyebrows, eyelashes, or beard hairs, are also frequently affected, with partial to total depigmentation.

• Punctate vitiligo.

  Sometimes referred to as leucoderma punctata, vitiligo punctata is a rare form of vitiligo characterized by small depigmented macules, typically round in shape and measuring between 1 and 1.5 mm in diameter. These well-defined lesions, often of uniform size, can appear on any area of the body.

• Hypochromic vitiligo.

  Hypochromic vitiligo, also known as minor vitiligo, is a specific form of vitiligo characterized by the presence of hypopigmented macules, meaning they are partially depigmented, rather than completely white. These lesions are primarily found on the face and neck, where they follow a seborrheic distribution, meaning they concentrate on areas rich in sebaceous glands. The vitiligo hypochromic seems to affect more people with dark skin, although this is not fully explained.

• Follicular vitiligo.

  Follicular vitiligo is a rare form of vitiligo where depigmentation is localized only to the mucous membranes or primarily on the hair. This loss of pigmentation in the hair is called leukotrichia.

Segmental vitiligo is a less common form of vitiligo than the non-segmental type. It accounts for approximately 10% of vitiligo cases. Segmental vitiligo has a unilateral distribution and is confined to a well-defined area of the skin, of varying size. The area in question is often a dermatome, that is, an area of the skin whose sensory nerves all originate from a single spinal nerve root. The face is most often affected, but this is not always the case. Segmental vitiligo differs from other clinical forms by an earlier onset age, sometimes rapid extension of the lesions to the entire dermatome, within about a year, then a halt in the spread. These observations suggest that vitiligo segmental develops according to a different mechanism than other forms.

Segmental vitiligo can be unisegmental, bisegmental, or multisegmental. In the case of unisegmental vitiligo, the white patches are present on a single dermatome. If the vitiligo is bisegmental, the lesions occupy two dermatomes. Finally, patches extending to multiple dermatomes indicate multisegmental vitiligo.

Mixed vitiligo is a rare form of vitiligo that initially presents as segmental vitiligo before expanding bilaterally within a variable timeframe, usually within a few months. Still relatively unknown, the mixed vitiligo can sometimes be difficult to diagnose, and even more challenging to treat. Its etiology is still poorly understood, but the involvement of genetic, autoimmune, and environmental factors, similar to those responsible for the onset of non-segmental vitiligo, is suspected.

Just like with any disease, the classification of vitiligo is crucial for understanding its progression and offering patients the most suitable treatments.

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