Chapter 4 – The Vagina and Vulva


Vitiligo is a common autoimmune disease which results in patchy, well-defined areas of complete loss of pigmentation on the skin which leads to a striking white discolouration. The skin retains its normal texture which is a distinguishing feature from lichen sclerosis. Vitiligo is asymptomatic but loss of pigmentation can be progressive over time and the cosmetic effect can lead to significant distress for the patient.

Vitiligo is a harmless condition but it can be associated with autoimmune thyroiditis. It affects both men and women and is not uncommonly seen on the genital skin, although face, hands, arms and legs are more common sites. It can be localised to one area of skin or be seen at multiple sites.

Diagnosis does not require skin biopsy and a simple method is to look at the skin in a darkened room under ultraviolet light as the affected skin fluoresces brightly. If there is any concern for the presence of lichen sclerosus a skin biopsy can be taken.

Treatment of vitiligo is difficult and may need to be used over many months before melanocytes return to the affected areas. Typical treatments are potent corticosteroid creams, tacrolimus, calcipotriol and topical psoralens on skin which can be exposed to sunlight.

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