Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(3):e2022114 1

Dermatology Practical & Conceptual

Dermoscopy for Facial Leukotrichia in Vitiligo:  
an Important Step for a Better Treatment Decision

Mohammed Ibrahim AlJasser1,2

1 Division of Dermatology, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

2 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

Citation: AlJasser MI. Dermoscopy for facial leukotrichia in vitiligo: An important step for a better treatment decision.  
Dermatol Pract Concept. 2022;12(3):e2022114. DOI: https://doi.org/10.5826/dpc.1203a114

Accepted: November 16, 2021; Published: July 2022

Copyright: ©2022 AlJasser. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Corresponding author: Mohammed I. AlJasser MBBS FRCPC, Associate Professor, Division of Dermatology, King Saud bin Abdulaziz 
University for Health Sciences, P.O. Box 3660, Riyadh 11481, Saudi Arabia, Tel: +966-11-4299999 ext. 95211, Fax: +966-11-429 9999 
Ext. 95148, E-mail: jasserm@ksau-hs.edu.sa; mj_derma@hotmail.com

Case Presentation 

A 14-year-old female with stable generalized vitiligo 

(body surface area 1%) was being treated with excimer 

laser and tacrolimus 0.1% ointment. She showed some 

re-pigmentation in some body sites such as the knees. How-

ever, facial patches showed very minimal re-pigmentation 

despite receiving many sessions of excimer laser. Dermos-

copy showed leukotrichia affecting the whole vitiliginous 

facial areas (Figure 1). The patient was therefore advised to 

undergo melanocyte transplantation. Topical and laser ther-

apy were discontinued.

Teaching point

Leukotrichia within vitiligo is known to be associated with 

poor response to medical and light therapy. Therefore, it 

is important to identify leukotrichia in order to predict re-

sponse to treatment within a given body site. It is often dif-

ficult to detect leukotrichia clinically especially in areas with 

fine vellus hair such as the face. Dermoscopy has recently 

emerged as a valuable tool in the assessment of vitiligo, es-

pecially for disease activity [1,2]. We find dermoscopy very 

helpful in detecting leukotrichia that cannot be seen clini-

cally by the naked eye, especially for facial patches.



2 Image Letter | Dermatol Pract Concept. 2022;12(3):e2022114

References

1. Jha AK, Sonthalia S, Lallas A. Dermoscopy as an evolving tool to 

assess vitiligo activity. J Am Acad Dermatol. 2018;78(5):1017–

1019. DOI: 10.1016/j.jaad.2017.12.009. PMID: 29229577.

2. Kumar Jha A, Sonthalia S, Lallas A, Chaudhary RKP.. Der-

moscopy in vitiligo: diagnosis and beyond. Int J Dermatol. 

2018;57(1):50–54. DOI: 10.1111/ijd.13795. PMID: 29076154.

Figure 1. (A) Facial vitiligo with minimal response to many sessions of excimer laser. (B) Polarized dermoscopy clearly demonstrate multiple 

white vellus hairs within vitiliginous skin . Leukotrichia was difficult to appreciate with the naked eye.