Onset following the death of a relative or after severe physical injury is often mentioned. Even sunburn reaction may precipitate vitiligo. The disease progresses by gradual enlargement of individual macules and the development of new white spots on various parts of the body. Vitiligo can be categorized as one of three types, based on the pattern of depigmentation. The most common type is generalized vitiligo, in which there is widespread distribution of white macules, often in a remarkably symmetrical array.
Typical macules occur in the fingers, elbows, knees, lower back, and genital area.
The segmental type, which is uncommon, is characterized by one of several macules on one hand or one side of the body. This type is not usually associated with vitiligo macules in other parts of the body, and new vitiligo spots do not appear. The diagnosis of vitiligo can usually be made on clinical examination of a patient with progressive, acquired, chalk-white macules in typical sites. Few conditions are as patterned and symmetrical as vitiligo. Sometimes the spots match on both extemities in a mirror-image.