Severity 

Depends on proportions of physical appearance and psychological impact. 

Mild:  Localised segmental Vitiligo. Non segmental Vitiligo sparing face and hands. Minimal psychological impact. 

• In absence of definitive treatment, for minimal disease with low psychological impact patients may not seek further treatment. 
• Recommend a high-factor (SPF50+) sunscreen with protection against ultraviolet A and B. 
• Check TSH and thyroid antibodies. 
• For adults with limited areas on trunk and limbs a potent topical steroid may be applied once daily (off licence) for up to 2 months 
• Not suitable for face and flexures. 
• Topical calcineurin inhibitor may be useful such as Tacrolimus 0.1% applied BD for face and flexures 
• Avoid use of sunbeds. 
• Provide contact details for Changing Faces for advice on skin camouflage and the Vitiligo Society for further information and support.

Moderate: More widespread.  Acrofacial.  Significant psychological impact. 

• Check TSH and thyroid antibodies. 
• For adults with limited areas on trunk and limbs a potent topical steroid may be applied once daily (off licence) for up to 2 months or daily for one week on one week off for longer periods of time. Not suitable for face and flexures. 
• Topical calcineurin inhibitor may be useful such as Tacrolimus 0.1% applied BD for face or flexures. Consider referral to secondary care if failing to respond to simple measures for further assessment  

Expert recommendations: camouflage 

• Self-tanning agents in gel, cream, lotion or spray: These give the skin a brown colour that resembles a natural tan and normally lasts from 3 to 5 days. 
• Highly pigmented cover creams: May require guidance on selection and application 

Severe:  Generalised / Universal / Active Progressive spread, Rapidly progressive spread and/or Major psychological impact 

For all patients for whom the condition is progressing rapidly; or where there is diagnostic uncertainty; or if the condition has a significant psychosocial impact; or the condition is not responding to topical treatment 

Refer to secondary care services for consideration of treatment with: 

• Topical steroids 
• Topical calcineurin inhibitor 
• Narrowband – UVB 
• Emerging treatments

NB. treatments may help but none are curative at present.

Severity 

Depends on proportions of physical appearance and psychological impact. 

Mild: Localised segmental Vitiligo. Non segmental Vitiligo sparing face and hands. Minimal psychological impact. 

Refer to secondary care: 

• If the condition is progressing rapidly 
• there is diagnostic uncertainty 
• the condition has a significant psychosocial impact, or 
• the condition is not responding to topical treatment. 

Moderate: More widespread.  Acrofacial.  Significant psychological impact. 

Refer to secondary care: 

• If the condition is progressing rapidly 
• there is diagnostic uncertainty 
• the condition has a significant psychosocial impact, or 
• the condition is not responding to topical treatment. 

Severe:  Generalised / Universal / Active Progressive spread, Rapidly progressive spread and/or Major psychological impact 

Refer to secondary care: 

• If the condition is progressing rapidly 
• there is diagnostic uncertainty 
• the condition has a significant psychosocial impact, or 
• the condition is not responding to topical treatment. 

NICE CKS – Vitiligo   

BAD Guidelines – Vitiligo (2021)

European Dermatology Forum vitiligo guidelines 2012 

PCDS- Vitiligo

DermNet NZ- Vitiligo 

• Be aware of possible association with other autoimmune disorders. 
• Post-inflammatory hypopigmentation can be common in skin of colour and should be clinically distinguishable from depigmentation seen in vitiligo, which may often be symmetrical. 
• Psychological effects are important. Vitiligo is often immediately visible to others and those with the condition may suffer social and emotional consequences including low self-esteem, social anxiety, depression, stigmatization and, in extreme cases, rejection by those around them. This can be accentuated in darker skin types, where loss of pigment is more visible. 

BAD patient information leaflet – Vitiligo:  

BAD patient information leaflet – Skin camouflage:   

Patient.info leaflet – Vitiligo:   

NHS Conditions- Vitiligo:  

Epidermal/ 

Appendageal 

ICD11 code - ED63.0