Diagnosing Vitiligo: Physical Exam, Labs, and When to Biopsy

"Diagnosing Vitiligo: Physical Exam, Labs, and When to Biopsy" takes up the practical side of diagnosis, from the exam room to the lab bench.

Dr. Desai lays out his evaluation protocol for a new vitiligo patient, beginning with a full-body skin exam even when a patient insists the disease is confined to one spot, since he finds unrecognized patches in most cases. He performs these exams with a chaperone present, given how self-conscious patients can feel about genital, breast, or periareolar involvement, and relies on a Wood's lamp and dermatoscope to pick up subtle early hypopigmentation and to guide photography. Baseline and follow-up photographs, he says, are essential for tracking disease over time, especially now that most practices can capture HIPAA-compliant digital images directly into the chart.

On history, Dr. Desai documents personal and family autoimmune disease and counsels patients who smoke, given known links between smoking and autoimmune activity. For laboratory testing, he checks a baseline TSH and free T4 if none has been done in the prior six months, along with a thyroid peroxidase antibody, a test he notes many dermatologists skip. He orders it because he has unmasked autoimmune thyroiditis in patients this way, though he is careful to explain that an elevated antibody alone does not mean a patient will develop overt Hashimoto's disease; it simply signals a need for primary care or endocrinology follow-up. He also checks vitamin D status, less because of any direct link to vitiligo than because he wants a general picture of the patient's health, and he avoids duplicating labs already done by a primary care provider. Finally, he tells colleagues not to hesitate to biopsy when the diagnosis is unclear, particularly in the hypopigmented differential he and Dr. Taylor discussed earlier in the program, since an early, accurate diagnosis shapes every treatment decision that follows.

Our next episode, "Vitiligo Emergency: 3 Warning Signs to Know," examines the physical signs that separate stable disease from a true vitiligo emergency.

This video was supported independently by Pfizer.