Complications

Complication
Timeframe
Likelihood
short term
medium

Up to 50% of patients report Koebner's phenomenon (i.e., depigmentation in response to trauma), which may indicate progressive disease. Prevention is primary.[60]

long term
high

Most vitiligo patients experience some degree of photosensitivity. Sunburn in the skin that lacks protection by melanin may be the first symptom of the disease. Sun protection including broad-spectrum sunscreen is effective in preventing sunburn.

Sunburn

long term
high

Chemically induced depigmentation is associated with permanent photosensitivity on the entire body. Laser-assisted melanocyte removal is often employed to avoid this complication where areas of involvement are small or sparse and localised depigmentation is desired.

long term
medium

With treatment of large areas, systemic corticosteroid effects may result. Minipulse therapy (i.e., the intermittent administration of larger doses) or alternate-day dosing has been advocated when using systemic corticosteroids.[42][51]

long term
low

Dermatoheliosis is the sum of chronic sun-induced cutaneous changes, ranging from wrinkling to potential cutaneous malignancies. Although lack of pigment in albinism (skin phototype I) is associated with early and enhanced dermatoheliosis, this association is not clearly present in vitiligo.[61]

long term
low

Conceptually, skin cancer risk should be increased in skin devoid of melanin protection.[62] There have been few reports of non-melanoma skin cancer developing in vitiligo, including in patients who had photochemotherapy. Reduced skin cancer risk has also been reported.[63][64][65]

Overview of skin cancer

variable
high

The contrast between affected and unaffected skin may create substantial interpersonal burdens. Clinicians should aim for early psychosocial evaluation and initiate support and treatment where needed.[39][41]

Depression

variable
high

Depigmentation may affect the epithelium of the retina and the choroid in up to 40% of patients. The incidence of uveitis is also elevated in patients with vitiligo.

Uveitis

variable
low

Audiological abnormalities can be measured in some patients with vitiligo, but this compromise is usually subclinical and generally does not affect their lives.[66]

Assessment of hearing loss

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