Advancing the Understanding and Management of Segmental Vitiligo and Co-Existing Pigmentary Disorders

Segmental vitiligo (SV) is a unique subtype of vitiligo that presents challenges in diagnosis and treatment, affecting 3.5%–20.5% of vitiligo cases. It typically appears in childhood, progresses rapidly within 6–24 months, and then stabilizes, with a 36% recurrence rate and 10% progressing to mixed vitiligo. Diagnosis is complicated by the overlap with non-segmental vitiligo (NSV) and the presence of halo nevi and leukotrichia. Current treatments include phototherapy, topical and systemic corticosteroids, and surgical interventions like autologous grafting. However, phototherapy is less effective for SV than NSV. Co-existing pigmentary disorders, such as melasma and post-inflammatory hyperpigmentation, complicate management, with promising treatments including oral tranexamic acid, topical tretinoin, and micro-needling. The need for refined diagnostic tools and comprehensive management guidelines is emphasized to improve patient outcomes.