As with most other skin problems, vitiligo can be identified by a general physician (GP) or Dermatologist after a physical examination of the patient. The diagnosis is then confirmed after taking into account their medical history and blood test reports as vitiligo may be associated with other underlying illnesses.
The physical exam will enable the doctor to observe all the patches on the patient’s body to ensure that conditions like dermatitis and psoriasis may be ruled out. Depending on availability, the doctor may use an Ultraviolet lamp, called a Wood’s Lamp to examine the patches in more detail. This will ensure that vitiligo is differentiated from other infective skin conditions like pityriasis versicolor (loss of pigment in small, round patches caused by a yeast infection).
The importance of physical examination also lies in the fact that it will allow the physician to estimate how much of the body area is affected and discuss the treatment options with the patient accordingly. A biopsy may also be performed by taking a small sample of affected skin for observation under the microscope. This will help the doctor rule out the possibility of other conditions like inflammation and infection.
The medical history of the patient includes questions about: A history of vitiligo or another autoimmune disease in the family; whether the patient has had sun sensitivity, like easy tanning, a rash, sunburn or other skin trauma within two to three months of the start of pigment loss; presence of other skin conditions like melanoma (a malignant tumor of melanocytes – the cells that produce the pigment in skin) or multiple, atypical moles.
Questions about graying of the hair (before age 35), stress or physical illness may also prove to be significant. To determine the best treatment the doctor can also ask whether any areas are showing improvement without treatment, or whether they are getting worse. History of any previous medications or treatments used also plays a role in deciding future management options for vitiligo.
In addition to the above requirements, to assess the presence of an underlying illness causing vitiligo, blood tests may be performed. A blood report will show the blood cell count, thyroid function and the presence of antinuclear antibodies (a type of autoantibody) that would indicate an autoimmune disease. The results will hence indicate whether diabetes, pernicious anemia (caused by insufficient absorption of vitamin B12 from the gut), hyperthyroidism or Addison’s disease (disorder of the adrenal glands) may be present and responsible for vitiligo. Diagnosing an associated illness is imperative as it will direct the respective treatment choices. An eye examination to check for inflammation in the eye (uveitis) may also be recommended by the doctor as it sometimes occurs alongside vitiligo.
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