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Dermoscopy for facial leukotrichia in vitiligo: An important step for a better treatment decision

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Case Presentation

A 14-year-old female with stable generalized vitiligo (body surface area 1%) was being treated with excimer laser and tacrolimus 0.1% ointment. She showed some re-pigmentation in some body sites such as the knees. However, facial patches showed very minimal re-pigmentation despite receiving many sessions of excimer laser. Dermoscopy showed leukotrichia affecting the whole vitiliginous facial areas ( Figure 1 ). The patient was therefore advised to undergo melanocyte transplantation. Topical and laser therapy were discontinued.

Figure 1 .

(A) Facial vitiligo with minimal response to many sessions of excimer laser. (B) Polarized dermoscopy clearly demonstrate multiple white vellus hairs within vitiliginous skin. Leukotrichia was difficult to appreciate with the naked eye.

Teaching point

Leukotrichia within vitiligo is known to be associated with poor response to medical and light therapy. Therefore, it is important to identify leukotrichia in order to predict response to treatment within a given body site. It is often difficult to detect leukotrichia clinically especially in areas with fine vellus hair such as the face. Dermoscopy has recently emerged as a valuable tool in the assessment of vitiligo, especially for disease activity [ 1 , 2 ] . We find dermoscopy very helpful in detecting leukotrichia that cannot be seen clinically by the naked eye, especially for facial patches.

References

  1. Dermoscopy as an evolving tool to assess vitiligo activity Jha AK, Sonthalia S, Lallas A. J Am Acad Dermatol.2018;78(5):1017-1019. CrossRef PubMed
  2. Dermoscopy in vitiligo: diagnosis and beyond Kumar Jha A, Sonthalia S, Lallas A, Chaudhary RKP. Int J Dermatol.2018;57(1):50-54. CrossRef PubMed

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