A 16-year-old girl presents with a 4-month history of well-demarcated, chalk-white depigmented macules over the left side of her face and neck, following a V1-V2 distribution. The lesions are unilateral and do not cross the midline. Wood's lamp examination accentuates the depigmentation. Early white hairs are noted within the affected patches. The condition marked **C** in the diagram is suspected. Which of the following statements best characterizes this condition and guides management?
A. Segmental vitiligo is symmetric, autoimmune-driven, and progressive; it requires long-term systemic immunosuppression and depigmentation therapy
B. Segmental vitiligo typically stabilizes within 6–24 months and is an ideal candidate for surgical therapy (e.g., NCECS) once stability is confirmed, especially when leukotrichia is present
C. Segmental vitiligo is congenital, stable from birth, and does not develop leukotrichia; it requires only cosmetic camouflage
D. Segmental vitiligo is hypopigmented with fine scaling and ill-defined borders; it responds well to topical corticosteroids alone without surgical intervention
Explanation
Why option 1 is right
Segmental vitiligo (SV) is characterized by unilateral, blaschkoid distribution with rapid onset (weeks to months) followed by stabilization within 6–24 months. Unlike non-segmental vitiligo, SV is NOT autoimmune-driven and does NOT progress indefinitely. Early leukotrichia (white hairs) is a hallmark feature that predicts poor response to medical therapy alone. Once SV stabilizes (typically after 12–24 months), it becomes an ideal candidate for surgical therapies such as non-cultured epidermal cell suspension (NCECS), suction blister grafting, or mini-punch grafting—the gold standard for stable, localized SV. The presence of leukotrichia indicates loss of follicular melanocytes, making medical therapy less effective and surgical intervention the best option. [Bolognia Dermatology 5e; VGICC Consensus on Vitiligo 2012]
Why each distractor is wrong
Option 2: Describes non-segmental vitiligo (NSV), not SV. NSV is symmetric, autoimmune-driven, and progressive; SV is unilateral, stabilizes, and has less autoimmune involvement. Depigmentation therapy is reserved for >80% body involvement (generalized vitiligo), not SV.
Option 3: Describes pityriasis alba (hypopigmented with fine scaling and ill-defined borders), which is a distractor in the differential diagnosis. SV presents with well-demarcated, chalk-white (depigmented, not hypopigmented) macules and requires surgical therapy for optimal outcomes when stable.
Option 4: Describes nevus depigmentosus, a congenital condition that is stable from birth and does NOT develop leukotrichia. SV has onset in childhood/adolescence, develops early leukotrichia, and is acquired, not congenital.
High-YieldNEET PG
Segmental vitiligo stabilizes within 6–24 months and is the BEST candidate for surgical therapy (NCECS) once stability is confirmed, especially when leukotrichia is present—medical therapy alone fails because follicular melanocytes are depleted.
Bolognia Dermatology 5e; VGICC Consensus on Vitiligo 2012
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