A 19-year-old boy with vitiligo notices that some older patches show three shades within the same lesion: a central chalk-white area, an intermediate tan zone, and normal-appearing peripheral skin. This pattern indicates:

• A Inflammatory vitiligo requiring systemic steroids
• B Quadrichrome vitiligo indicating active disease
• C Confetti-like depigmentation suggesting drug-induced vitiligo
• D Trichrome vitiligo, an intermediate stage between normal skin and complete depigmentation ✓

Explanation

Trichrome vitiligo shows three tones: central depigmented white, surrounding hypopigmented tan, and peripheral normal skin. It represents partial loss of melanocytes and is considered a transitional stage toward complete depigmentation, often seen in active disease. Quadrichrome adds a fourth blue-grey tone, confetti lesions are small discrete macules, and inflammatory vitiligo shows raised erythematous borders instead.

Reference: Fitzpatrick's Dermatology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.