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Here is a full visual gallery of asymmetrical vitiligo from authoritative dermatology textbooks and peer-reviewed sources, with clinical context for each image.

Vitiligo - Asymmetrical Patterns

Asymmetrical vitiligo falls mainly under segmental vitiligo (SV) and sometimes focal vitiligo. Unlike the more common non-segmental (generalized) vitiligo - which tends toward bilateral symmetry - segmental vitiligo is defined by its unilateral, block-shaped, asymmetric distribution confined to one body segment.

Image 1 - Segmental Vitiligo: Unilateral Block-like Depigmentation (Lower Abdomen)

(Fitzpatrick's Dermatology, Fig. 76-4)

Segmental vitiligo - unilateral block-like depigmentation of the lower abdomen

A classic example of segmental vitiligo showing a unilateral, well-defined depigmented patch confined to one side of the lower abdomen. This "block-like" asymmetrical pattern is highly characteristic of segmental disease.

Image 2 - Mixed Vitiligo: Segmental + Remote Bilateral Lesions

(Fitzpatrick's Dermatology, Fig. 76-5)

Mixed vitiligo - segmental back lesion plus bilateral asymmetrical lesions on limbs

Mixed vitiligo - a segmental lesion on the back (upper left, unilateral) coexisting with additional irregular, asymmetrically distributed patches across the arms, thighs, and legs. The overall pattern is markedly asymmetrical, with heavier involvement on one side.

Image 3 - Generalized Vitiligo with Asymmetrical Confetti-like Patches

(Fitzpatrick's Dermatology, Fig. 76-2)

Widespread vitiligo with asymmetrical confetti-like patches on torso and arms

Extensive vitiligo with numerous small and large white macules scattered unevenly across the torso and arms. While generalized vitiligo tends toward symmetry, individual lesions show considerable asymmetry in size, shape, and distribution.

Image 4 - Vitiligo: Multiple Body Sites with Asymmetrical Distribution (JCI)

(Journal of Clinical Investigation)

Vitiligo affecting torso, perioral region, and back with asymmetrical depigmented patches

A composite panel (A-E) showing:

(A) Torso with unequal, asymmetric depigmented areas
(B) Large asymmetric confluent patches on trunk/abdomen
(C) Perioral/lip vitiligo (focal, unilateral involvement)
(D) Large asymmetric patch on the upper back
(E) Vitiligo on hands and flank with asymmetric spread

Image 5 - Inflammatory Vitiligo, Focal Asymmetric Lesion, and Lip/Hand Variants

(CosmodermaJournal)

Inflammatory vitiligo with focal asymmetric patch, confetti pattern on back, and lip vitiligo

(a) Single focal asymmetric depigmented patch with an erythematous (inflammatory) border - active disease
(b) Subtle focal vitiligo on the hand/fingers
(c) Confetti-like depigmentation on the back - a marker of active, spreading disease
(d) Lip mucosal vitiligo - focal and asymmetric

Key Clinical Points

Feature	Segmental (Asymmetric)	Non-Segmental (Symmetric)
Distribution	Unilateral, one segment	Bilateral, symmetric
Prevalence	10-15% of cases	~85-90%
Progression	Rapid spread within 6-12 months, then stabilizes	Progressive over years
Poliosis (white hairs)	Common, early	Less common early
Autoimmune associations	Weak	Strong
Treatment response	Typically resistant to systemic therapy	Better response to phototherapy/immunosuppressants

Segmental vitiligo tends to stabilize after its initial rapid spread, whereas non-segmental vitiligo may continue spreading unpredictably over a lifetime. The asymmetrical "block" pattern is considered pathognomonic for the segmental subtype.

Fitzpatrick's Dermatology, Chapter 76 (Ezzedine & Harris)
Dermatology 2-Volume Set 5e, Chapter 66

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