OSCE — Vitiligo & Pigmentation Disorders

Brief (to candidate)

You will assess a patient with a presentation consistent with Vitiligo & Pigmentation Disorders.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Vitiligo is an acquired autoimmune destruction of epidermal melanocytes producing well-demarcated, chalk-white (depigmented) macules and patches on the periorificial face, hands, extensor surfaces, genitalia and body folds; classified as segmental (unilateral, dermatomal, early onset, stabilises within 1 to 2 years) or non-segmental (bilateral, symmetrical, progressive). It is associated with autoimmune thyroid disease, type 1 diabetes, pernicious anaemia, Addison disease and alopecia areata, and carries a major psychological burden, especially in darker skin. Melasma (chloasma) is acquired symmetrical facial hyperpigmentation (forehead, malar cheeks, upper lip) triggered by sun exposure, pregnancy and combined oral contraceptives.^[2]

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]