Segmental Vitiligo: What Makes It Different from Other Types?

Vitiligo is a skin condition characterized by depigmented patches on the skin, which lead to the development of white patches on various parts of the body. Among the two types of vitiligo, segmented vitiligo requires special attention as it is unique in its characteristics.

In this blog, we’ll deeply dive into this type of vitiligo, answer the common question, “What is segmental vitiligo?”, and explore what sets it apart from other types of vitiligo.

What Is Segmental Vitiligo?

SV affects around 5% of adults and approximately 20% of children. The condition usually affects younger individuals. This type of vitiligo shows an asymmetric pattern, usually affecting one side of the body. Unlike the non-segmental type, which impacts the body symmetrically across the body, the segmental type impacts just one side.

A typical presentation might involve white patches on just one arm, leg, or side of the face. Once it spreads to its final extent, usually within 6 to 12 months, it often stops progressing, which contrasts sharply with the chronic and progressive nature of non-segmental type.

How Segmental Vitiligo Differs from Non-Segmental Type?

In addition to the appearance, it is necessary to understand the difference between segmental vs the other types, especially non-segmental vitiligo. Here are the primary distinctions:

Patterns of Distribution

SV affects one side of the body or follows a dermatomal pattern (the area of skin supplied by a single spinal nerve). On the other hand, the non-segmental type is usually bilateral and symmetrical, meaning if a white patch appears on the left hand, a similar patch is likely to appear on the right.

Onset and Progression

SV progresses rapidly but then stabilizes, often within a year. Non-segmental vitiligo, however, typically develops more slowly and can continue to spread over a person’s lifetime. Moreover, like any other vitiligo type, segmental vitiligo also has a genetic linkage; however, environmental factors also lay behind.

Autoimmune Association

Non-segmental vitiligo has a strong connection with autoimmune conditions like thyroid disease or type 1 diabetes. Contrary to this, the segmental type has a weaker autoimmune component. This suggests different underlying mechanisms driving the two forms.

Causes and Risk Factors of SV

The exact cause is still unknown. However, researchers believe that some known mechanisms are likely to be behind its onset and development. One cause is autoimmunity, which causes the immune system to attack the pigment producing cells called melanocytes.

Another identified cause is the unusual cell changes during the embryonic stage of development. The development of SV may also be influenced by the neurological system. Chemicals released by nerve cells in the skin may be a factor in melanocyte loss.

Additionally, stress, skin injury, and specific chemical exposures can all cause vitiligo to appear. There have been isolated reports of drug-induced SV. Specifically, SV case reports have been linked to the medication infliximab, which is marketed under several names, including Remicade and Renflexis.

Diagnosis and Clinical Features

Diagnosing SV involves a combination of physical examination and clinical history. Dermatologists often use a Wood’s lamp, which emits ultraviolet light to highlight depigmented patches, making them easier to identify.

Key signs include:

• Unilateral white patches that do not cross the midline
• Rapid development followed by stabilization
• Lack of associated autoimmune symptoms
• Hair within the affected area may also lose color (leukotrichia)

Additionally, it’s necessary not to confuse SV with other localized skin disorders like tinea versicolor or post-inflammatory hypopigmentation. An accurate diagnosis ensures that the treatment approach aligns with the unique nature of the condition.

Treatment Options for Segmental Vitiligo

There is no cure for this type of vitiligo. However, certain treatment options can help manage the condition. These therapies aim to improve the affected skin appearance. However, there are clincial trials ongoing to test new drugs and therapies to find a better cure for vitiligo. All it demands is your noble contribution to help promote research.

Here are the available treatment options for managing this condition:

Topical Treatments

In the early stages, doctors may prescribe topical corticosteroids or calcineurin inhibitors to reduce inflammation and stimulate pigment production. However, these are more effective in non-segmental types and may have a limited impact on segmental cases.

Surgical Interventions

Once SV has stabilized (usually after 6–12 months), surgical options become viable. These include:

• Melanocyte transplants: Transferring healthy melanocytes from unaffected skin
• Punch grafting: Small pieces of pigmented skin are grafted onto depigmented areas
• Blister grafting: A less invasive form of skin grafting that uses suction blisters

Surgery tends to offer better long-term results for this type of vitiligo compared to medical therapy.

Laser and Light-Based Treatments

Although narrowband UVB therapy is standard for the non-segmental counterpart, its effect on SV is modest at best. Excimer lasers may offer targeted pigment restoration in smaller patches.

Prognosis and Psychological Impact

As in any type of vitiligo, SV can have a major psychological impact, especially on younger individuals. Especially talking about facial involvements, they may affect self-esteem and social confidence.

The good news is that segmental vitiligo tends to remain stable over time, and many patients see positive results with surgical interventions. Early diagnosis and a supportive care plan, including counseling if needed, can improve quality of life.

The Importance of Clinical Trials

We have discussed earlier that clinical trials are ongoing to find better and potent treatment options for vitiligo. There are clinical trials ongoing for both adults and pediatrics to find a better treatment option and help you live again with confidence and self-esteem. Your participation thus plays a main role in advancing research and helping future generations overcome vitiligo.

Additionally, clinical trials aim to find better treatment options by testing new drugs and therapies on eligible participants. Having a team of professionals and state-of-the-art therapies, the clinical research sites aim to improve the current therapies and find a better cure.

Conclusion

To conclude, segmental vitiligo is a distinct form of vitiligo that differs significantly from its more common counterpart. Its unilateral presentation, early onset, rapid stabilization, and different treatment response make it a unique challenge for both patients and healthcare providers.

Additionally, by distinguishing it from non-segmental forms and focusing on early diagnosis and appropriate treatment, especially surgical options, patients can achieve better cosmetic and psychological outcomes.