What are the correct types of vitiligo: A. Dichrome, Trichrome, poliosis, B. Dichrome, Trichrome, Scarring, or C. Dichrome, Trichrome, scaling?

Types of Vitiligo

The correct types of vitiligo are A. Dichrome, Trichrome, poliosis. 1

Understanding Vitiligo Variants

Vitiligo is an autoimmune disease characterized by the destruction of melanocytes resulting in depigmented patches of skin. While the basic presentation involves white patches, several distinct variants exist based on the pattern of pigmentation:

Confirmed Vitiligo Types

1. Dichrome Vitiligo

   • Characterized by two distinct colors: the normal skin tone and completely depigmented white patches
   • Represents the classic presentation of vitiligo

2. Trichrome Vitiligo

   • Features three colors: normal skin, completely depigmented white areas, and an intermediate hypopigmented zone between them
   • This intermediate zone represents active disease progression 2
   • Previously described primarily in non-segmental vitiligo but can occur in segmental type as well 2

3. Poliosis

   • Refers to the whitening of hair in vitiligo-affected areas
   • Occurs due to melanocyte destruction in hair follicles
   • Commonly seen in scalp, eyebrows, and eyelashes

Additional Variants (Not in the Options)

• Quadrichrome Vitiligo

  • Features four color zones including hyperpigmented borders
  • Represents different stages of disease activity

• Pentachrome Vitiligo

  • A rare variant with five distinct color zones
  • Includes white, tan, medium brown (unaffected skin), dark brown, and black areas 3

Clinical Significance of Vitiligo Types

Understanding these variants has important clinical implications:

• Disease Activity: Trichrome vitiligo often indicates active disease progression and may be resistant to treatment 2

• Treatment Response: Different variants may respond differently to therapy, with trichrome vitiligo in segmental type showing poor response to phototherapy and systemic steroids 2

• Prognosis: The presence of multiple color zones may indicate a more dynamic disease process

Diagnostic Considerations

When evaluating vitiligo, clinicians should:

• Use Wood's light examination to help delineate areas of pigment loss, especially in lighter skin types 1

• Document the presence of different color zones as this may influence treatment approach and prognosis

• Consider associated conditions, as vitiligo may be linked with other autoimmune disorders 1

Important Clinical Pitfalls

• Do not confuse trichrome vitiligo with other disorders that can present with hypopigmentation such as post-inflammatory hypopigmentation or pityriasis versicolor

• The presence of scaling (option C) is not a characteristic feature of vitiligo and would suggest an alternative diagnosis

• Scarring (option B) is not typically associated with vitiligo unless there has been trauma or inappropriate treatment to the affected areas

• Always assess for disease stability before considering surgical treatments to avoid Koebner phenomenon 1

The British Journal of Dermatology guidelines emphasize the importance of accurate classification of vitiligo for appropriate management and treatment selection 4.