Focal Vitiligo and generalized vitiligo both can start as a simple focus, of hypopigmentation. How can one be sure to say that the lesion is focal. Can a simple epidermal graft cure focal Vitiligo, or should the same treatment be followed as in generalized Vitiligo?
A female patient presented with vitiligo had undergone simple epidermal graft. Alas! she developed white patches adjacent to the graft.
It depends on age of presentation and evolution. A stable, dermatomeric, depigmented macule abrupted in a child and stable in its evolution in months/years can be described as a segmental focal vitiligo; on the other hand, a new lesion in an adult, with tendency to grow dimensionally during short time, requires a more strict follow up to exclude a possible evolution to non segmental form and correct systemic laboratory examination to exclude concurrent autoimmune disorder such as Hashimoto or Basedow tyroiditis. Epidermal graft and all possible surgical and physical intervention are restricted to very limited number of selected patients, that should be treated first line with topical treatment (corticosteroids, calcineurin inhibitors) and/or medical phototherapy (PUVA, UVBnb, UVA1, for example) and camouflage.
Vitiligo has unpredictable course ,so no available parameters to ascertain about the state condition except the condition at time the patient has been seen as focal progressing to generalized or generalized from the beginning. Start with usual modalities of treatment then shift to other for refractory or recalcitrant cases.
Defining the stability of vitiligo has gone down to the molecular level...but treatment can only be guided by what the clinician sees and history the patient gives..
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