Derm Cases · Dermatology / General Medicine / Paediatrics interface
OSCE — assessment of non-segmental vitiligo with activity and treatment planning
An 8-minute OSCE station on classification of vitiligo (segmental vs non-segmental), activity assessment (Koebner, confetti, trichrome), autoimmune screening, photoprotection and stepwise repigmentation therapy including topical calcineurin inhibitors, NB-UVB and counselling on expectations.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station on classification of vitiligo (segmental vs non-segmental), activity assessment (Koebner, confetti, trichrome), autoimmune screening, photoprotection and stepwise repigmentation therapy including topical calcineurin inhibitors, NB-UVB and counselling on expectations.
Brief (to candidate)
A 28-year-old woman has progressive well-demarcated milky-white patches on the hands, face and elbows for 18 months. New tiny confetti-like macules at the edges; she notes new spots after cuts. Family history of thyroid disease. You have 8 minutes to classify disease, assess activity, screen associations, and plan evidence-based therapy with realistic counselling.
Candidate instructions
- Classify segmental vs non-segmental (and mixed) vitiligo.
- Assess disease activity (Koebner, confetti, trichrome, Koebner history).
- Screen for autoimmune thyroid and other associations; examine mucosa/hair for leukotrichia.
- Outline stepwise treatment (topical, phototherapy, systemic stabilisation, surgery for stable disease).
- Counsel on photoprotection, camouflage, psychology, and expectations for repigmentation.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Recognition & classification | Acquired depigmented macules/patches; classifies non-segmental (bilateral, acrofacial/generalised) vs segmental (unilateral dermatomal) per VGICC nomenclature[1][3] |
| Activity signs | Koebner phenomenon, confetti-like macules, trichrome lesions, inflammatory borders → active disease; history of trauma-induced lesions[7] |
| Exam & differentials | Wood lamp enhancement if available; leukotrichia implies follicular reservoir loss (harder repigmentation); DDx: piebaldism, chemical leukoderma, post-inflammatory hypopigmentation, tinea versicolor, leprosy (sensory exam if relevant) |
| Associations | Screens thyroid autoimmunity (TSH ± antibodies); other autoimmune disease; family history; quality-of-life/psychological impact |
| Medical therapy | Face/neck: topical calcineurin inhibitors preferred; body: potent topical corticosteroid courses; narrowband UVB first-line phototherapy for extensive/active disease; discuss systemic options/JAK inhibitors only in appropriate specialist context per current guidelines[2] |
| Stable disease options | After stability (often ≥6–12 months): surgical melanocyte/tissue grafting for selected residual patches; camouflage and depigmentation only for extensive refractory disease after counselling |
| Safety & communication | Photoprotection of depigmented skin (burn risk); sets realistic timelines (months); offers psychosocial support; avoid false promise of rapid cure |
Model key actions
- Diagnose active non-segmental vitiligo with Koebner/confetti activity signs.[1][3][7]
- Screen thyroid function; start site-appropriate topical therapy and refer/consider NB-UVB for progressive extensive disease.[2]
- Counsel photoprotection, psychology, and repigmentation expectations; reserve surgery for stable disease.
Common errors
- Calling every white patch vitiligo without differential (especially leprosy in endemic settings).
- Offering surgery during active progressive disease.
- Using only camouflage without discussing medical repigmentation options.
- Omitting thyroid screening and psychosocial impact.
- Prolonged potent steroids on the face without TCI option.
References5ShowHide
- [1]Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet, 2015.PMID 25596811
- [2]Eleftheriadou V, Atkar R, Batchelor J, et al. British Association of Dermatologists guidelines for the management of people with vitiligo 2021. British Journal of Dermatology, 2022.PMID 34160061
- [3]Ezzedine K, Lim HW, Suzuki T, Katayama I, et al. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell & Melanoma Research, 2012.PMID 22417114
- [7]van Geel N, Speeckaert R, Taieb A, et al. Koebner's phenomenon in vitiligo: European position paper. Pigment Cell & Melanoma Research, 2011.PMID 21324101
- [8]El Mofty M, Essmat S, Youssef R, et al. The role of systemic steroids and phototherapy in the treatment of stable vitiligo: a randomized controlled trial Dermatol Ther, 2016.PMID 27528547