From the Guidelines
Circular patterns of skin pigmentation loss are most commonly caused by vitiligo, which results from autoimmune destruction of melanocytes, creating well-defined white patches that may gradually enlarge. According to the guideline for the diagnosis and management of vitiligo 1, vitiligo is an acquired chronic depigmentation disorder characterized by white patches, often symmetrical and increasing in size with time. The commonest sites to be affected are the fingers and wrists, the axillae and groins, and the body orifices such as the mouth, eyes, and genitalia.
Some key points to consider in the diagnosis and management of vitiligo include:
- The use of potent or very potent topical steroids for a trial period of no more than 2 months in adults with recent onset of vitiligo 1
- The consideration of topical pimecrolimus as an alternative to topical steroids, based on its better side-effect profile 1
- The reservation of depigmentation with p-(benzyloxy)phenol for patients severely affected by vitiligo who cannot or choose not to seek repigmentation 1
- The recommendation to use NB-UVB phototherapy in preference to oral PUVA for treating nonsegmental vitiligo 1
It is essential to consult a dermatologist for proper diagnosis, as treatment approaches differ significantly based on the underlying cause. Other potential causes of circular patterns of skin pigmentation loss include tinea versicolor, pityriasis alba, and post-inflammatory hypopigmentation, which require different treatment approaches.
From the Research
Causes of Skin Pigmentation Loss in Circular Pattern
- Vitiligo is a condition characterized by the loss of skin pigmentation, resulting in white patches on the skin 2, 3, 4, 5, 6
- The exact cause of vitiligo is not fully understood, but it is believed to be an autoimmune disease where the immune system attacks and destroys melanocytes, the cells responsible for skin pigmentation 5
- Research suggests that autoreactive cytotoxic CD8+ T cells play a key role in the pathogenesis of vitiligo, promoting disease progression through the local production of IFN-γ 5
- Vitiligo can present in a circular pattern, although the shape and size of the patches can vary 2, 3, 4
Treatment Options
- Narrowband UVB (NB-UVB) phototherapy is a common treatment for vitiligo, which can help restore skin pigmentation 2, 3, 4, 6
- Topical immunomodulators, such as pimecrolimus and tacrolimus, can also be effective in treating vitiligo, especially when combined with NB-UVB phototherapy 2, 6
- The response to treatment can vary depending on the location of the lesions, with better results often seen on the face and neck 4, 6
Factors Influencing Treatment Response
- The location of the lesions can affect treatment response, with non-acral areas (e.g. face, neck) tend to respond better to treatment than acral areas (e.g. hands, feet) 3, 4
- The duration of treatment can also impact response, with longer treatment durations often leading to better outcomes 4
- Individual factors, such as family history and previous treatments, can also influence treatment response 3