Subclinical (Invisible/Unseen) Vitiligo

Background: Vitiligo is considered the most common acquired pigmentation disorder affecting about 1%–2% of the world’s population; characterized by the development of well-defined depigmented macules on the skin that reflect the loss of epidermal melanocytes. The etiopathology of the disease has not been well defined, but multiple factors contribute to melanocyte loss: autoimmunity, genetic, oxidative stress, and neurological system dysfunction. The majority of diagnostic criteria are based on clinical findings of acquired, clearly defined white lesions on the skin that do not have any associated inflammation and tend to expand centrifugally. Depending on our observation, some hypopigmented and even depigmented lesions may not be easily recognizable or detectable by the naked eye but appear obviously upon examination using Wood’s light. Wood’s light examination becomes essential in such cases for better recognition and definition of the lesions. Aim: The aim of this study was to use Wood’s light for diagnosis of what is termed “Invisible, subclinical or unseen vitiligo” as early detection of such lesions could help in early diagnosis; hence, early intervention. Results: Wood’s light examination revealed areas of hypopigmentation within the area of actual vitiligo lesions which was not seen clinically. Even actual vitiligo lesions’ surface area, as perceived by the dermatologist lesions delineated under Wood’s lamp, were significantly larger than those seen by the naked eye due to the detection of new clinically invisible lesions and/or invisible extensions to clinically visible lesions. These lesions were discovered by the use of Wood’s light (unseen, invisible, or subclinical). Conclusion: Wood’s light should be used for every patient complaining of vitiligo in order to detect the presence of what is called “invisible, subclinical, or unseen vitiligo lesions.” Once we find these lesions, early intervention with proper treatment, especially systemic ones, stops progression and improves outcomes.