White skull, uneven face skin, vitig?

Thanks for the query. Vitiligo is an immune system mediated skin disease which can be brought into remission by certain medications and life style changes. Now it is believed to be a multisystem disorder that can have other auto-immune comorbidities. A proper assessment to determine the presence and severity of these comorbidities is needed. There are basically 2 components of therapy – first is to stop the spread of the disease and second is to refill colour. There are different ways of doing that and it differs from patient to patient. If you have tried medical therapy and have not achieved desired results, you can consider surgical options like suction blister grafts/non cultured melanocytes suspension. It requires expertise to perform and results take few months to be visible. The prerequisite for surgery is stable disease for atleast a year. Most of the patients do well if they stick to the recommendations.

Vitiligo should be ruled out.

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