Vitiligo and Its Mimics in Childhood: A Diagnostic Framework for Hypopigmented Disorders

Hypopigmented disorders in childhood encompass a broad spectrum of presentations, including depigmentation, hypopigmentation, and pseudo-hypopigmentation arising from non-melanin mechanisms. In clinical practice, the primary challenge often lies in distinguishing these conditions from vitiligo, the most common acquired depigmentation disorder. Although vitiligo is categorized into nonsegmental and segmental subtypes, many children initially present with an undetermined or focal form before the clinical subtype is clearly established. A systematic diagnostic approach begins with Wood's lamp examination and ultraviolet photography to distinguish complete depigmentation from partial hypopigmentation, followed by assessment of onset, extent, distribution, and associated extracutaneous manifestations. Accurate diagnosis enables early therapeutic intervention for vitiligo, averts unnecessary anxiety regarding self-limiting conditions, and prompts appropriate systemic evaluation. This review provides a comprehensive, evidence-based clinical framework for the differential diagnosis of pediatric hypopigmented disorders, highlighting key diagnostic clues to facilitate accurate diagnosis and optimal management.