Choosing Initial Treatment Options in a Patient with Vitiligo

A 22-year-old woman presents with progressive areas of depigmentation on her upper arm and shoulder that have developed over the past 8 months. She reports no associated itching, scaling, or pain. The lesions have gradually increased in size and are more noticeable after sun exposure. Physical examination reveals well-demarcated depigmented macules and patches with a confetti-like pattern on a background of normally pigmented skin (as shown in the photo). The remainder of her skin exam is normal.

Photo Credit: John Harris, MD PhD