Cancer, pigmentation, hair and nails
Pigment disorders
Overview
Common causes include vitiligo, post-inflammatory change, melasma, pityriasis versicolor and medication/systemic disease. Distinguish hypo-, de- and hyperpigmentation.
- Vitiligo: loss of skin melanocytes causing depigmented patches; cause unknown with likely genetic and autoimmune factors; diagnosis is usually clear on examination (1).
Assessment
Onset, progression, inflammation, sun exposure, pregnancy/hormones, medications, autoimmune symptoms and psychosocial impact. Examine distribution, scale, hair involvement and mucosae.
Red flags
A new or changing irregular pigmented lesion, systemic symptoms with diffuse pigmentation, or ocular/mucosal involvement requires targeted specialist assessment.
Investigations
Wood lamp, skin scraping and targeted autoimmune/endocrine testing when indicated. Biopsy atypical lesions rather than empirically treating indefinitely.
Management
Treat underlying inflammation or infection, use sun protection and discuss realistic repigmentation expectations. Vitiligo may use topical anti-inflammatory therapy or phototherapy under guidance.
- Vitiligo: topical corticosteroids (often with calcipotriol), topical calcineurin inhibitors (tacrolimus, pimecrolimus) and narrowband UVB; widespread disease is treated with narrowband UVB (1).
References
Last updated from Sen’s notes on 9 October 2026.