Vitiligo: classification ,severity scoring system and psychosocial impact



The Vitiligo European Taskforce came to a consensus about the classification of vitiligo in 2007.

They decided on four main categories with subtypes. Classification  Subtype  Comments 
Nonsegmental vitiligo   Focal 

 Mucosal 

 Acrofacial 

 Generalised 

 Universal 

bilateral and symmetrical in distribution. 

Stable or unstable 

Segmental vitiligo   Focal 

 Mucosal 

 Unisegmental, bi- or multisegmental 

Single white patch in 90% 

Border often irregular 

Affects young people 


Cutaneous mosaicism 

Mixed vitiligo   Nonsegmental combined with segmental vitiligo  Rare 
Unclassified vitiligo   Focal at onset 

 Multifocal asymmetrical non-segmental 

 Unifocal mucosal 

Early disease 




At least two scoring systems have been devised for vitiligo and are used in clinical trials. 

 Vitiligo Area Scoring Index (VASI) 

 Vitiligo European Task Force (VETF) system 


VASI : It measures the extent and degree of depigmentation in 6 sites: hands, upper extremities, trunk, lower extremities and feet, head/neck. 

VETF: The VETF assesses the extent, staging and spreading/progression in 5 sites: head/neck, trunk, arms, legs and hands/feet. It grades from 0 (normal pigmentation) to 4 (complete hair whitening). Spreading is assessed using the following scores: 0 (stable disease), -1 (regressive disease) and +1 (progressive disease) 


Because vitiligo affects a person’s physical appearance, there are various associated psychological and social impacts. Higher levels of depression and social anxiety have been reported in patients with vitiligo. Patients may also experience low self-esteem, social stigmatization, shame, avoidance of intimacy, adjustment disorder, fear, suicidal ideation, and other psychiatric morbidities .Family support, counselling and cognitive behavioural treatment can be of benefit. 


Written by: Abdul Aziz Al-mufadhi, PGY1 Dermatology Resident 





bolognia dermatology 4th edition