How do I take a photo I can compare with last month's?
Keep the setup the same every time. Same light, same distance, same angle, same body position. Put something fixed in the frame so scale is obvious. Then keep the date on the file. Evidence Evidence
- A plain, solid background behind the patch. Black, green or dark blue make skin stand out.
- The same light in the same place. A photo guide for vitiligo names one fixed lamp rather than sunlight, because sunlight shifts through the day. Daylight from one window at a set hour is the home version of that idea.
- No flash. It fires a little differently each time and changes the color of skin.
- The camera held straight, not tilted up or down.
- About 3 to 5 feet away, the same every time.
- The same body areas, in the same order, at each session.
- A ruler or another fixed object in frame for scale.
- Your body in the same position. A hand flat, an arm straight, a face level.
Why this matters
- Sources cited, not yet graded
The British vitiligo guideline I read recognizes medical photography as one way to document vitiligo over time. I pulled the home version of the same setup from a doctor-reviewed guide for people with vitiligo.
Considerations
- Depends on you
Phones adjust color, contrast and exposure on their own. Two photos taken the same way can still differ. A matched pair is easier to compare, not a measurement.
Questions for your dermatologist
Would photos of ___ help you at our next review, or is a written note enough?
Saving keeps this on your device and needs JavaScript, which is off in this browser.Is there an angle or a marker you want me to use for ___?
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Do I need a Wood lamp at home?
No. A Wood lamp exam, sometimes called a black light test, is a clinic tool. It belongs in a darkened room with a clinician holding it close to your skin. Your monthly photos can be taken in ordinary light. Evidence Evidence Evidence
Why this matters
- Sources cited, not yet graded
I compared two descriptions of the test. DermNet describes a fully darkened room, with the lamp held about 10 to 30 cm away. MedlinePlus describes the same test in a dermatologist office, with the lamp 4 to 5 inches from the skin. A review of vitiligo diagnostics reports that patches outlined under a Wood lamp looked much more prominent. That led to finding new patches, and to finding that known patches had spread.
Considerations
- Depends on you
MedlinePlus warns not to look directly into the ultraviolet light. The same review grades four limits on the method. False negatives are one, above all in darker skin tones, and a result that depends on who holds the lamp is another. A clinic exam is not something a home photo series replaces, and the reverse holds too.
Questions for your dermatologist
Do you use a Wood lamp when you check my patches?
Saving keeps this on your device and needs JavaScript, which is off in this browser.Would a Wood lamp exam change what we do next about ___?
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Why do my patches look bigger in some photos and smaller in others?
Often because the skin around them changed, not the patch. The American Academy of Dermatology page I read says tanning increases the contrast between your natural skin color and the light patches. More contrast is what makes vitiligo more noticeable. Bright light in a photo can do something similar. Evidence
Why this matters
- Sources cited, not yet graded
The same page tells you to avoid tanning, indoors and outdoors, for that reason. It says a bad sunburn can worsen vitiligo. It also says that on a lighter skin tone, untanned skin often makes the spots and patches less noticeable.
Considerations
- Depends on you
I looked for a number on how much tanning shifts contrast and found none, and the page acknowledges support from Incyte Dermatology. Season, surrounding skin color and camera processing all move how a patch reads. A patch that looks bigger this month may only be standing out more.
Questions for your dermatologist
My patches look sharper after a summer outdoors. Is that the vitiligo moving, or the contrast?
Saving keeps this on your device and needs JavaScript, which is off in this browser.How should I read a photo taken after a lot of sun on ___?
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What am I looking for when I compare the two photos?
Two things. The edge of a patch, and any small islands of color inside it. Both feed the question your dermatologist is actually asking: is this vitiligo active right now, or settled? Evidence Evidence
Why this matters
- Sources cited, not yet graded
Knowing whether a treatment is working, week to week, is what most readers are really after here. The International Vitiligo Task Force recommendations treat active vitiligo and stable vitiligo as two different states, and the state changes the care plan. Its checklist records where the patches are and what the vitiligo has done in the past six months. The British guideline plans care around what is there to work with, and names hair that still has its color as its example.
Considerations
- Depends on you
An edge can look crisper because of light or angle rather than because it moved. Color can return unevenly across body sites. The British guideline says a doctor cannot always tell whether vitiligo has truly stopped changing, so a photo pair will not settle it either.
Questions for your dermatologist
When you compare these two photos of ___, what counts as a real change to you?
Saving keeps this on your device and needs JavaScript, which is off in this browser.Should I photograph the edge of a patch closer up, or keep the whole area in frame?
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What should I write down beside each photo?
A few lines are enough. Any new patch and where it is. Time spent in the sun, and whether skin burned. Which treatment you used, and any reaction to it. The questions you want answered next visit. Evidence Evidence
Why this matters
- Sources cited, not yet graded
The British guideline I read builds a vitiligo review out of clinical history and assessment, associated conditions, psychosocial impact, and the treatment options on the table. The task force records where the patches are as a feature of its own, keeps white hairs as a separate item, and asks what you want from care.
Considerations
- Depends on you
A record can miss a change, or catch something unrelated to vitiligo. More entries do not make a reading more accurate. What any observation means for your care is a clinician call, made with your history and an exam.
Questions for your dermatologist
What would you like me to write down before my next appointment?
Saving keeps this on your device and needs JavaScript, which is off in this browser.Which reactions to ___ should I report right away instead of waiting?
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What does a dated record do at the appointment, or with an insurer?
It turns a memory into a date. Your dermatologist can see when a patch showed up and how fast it moved. An insurer asking what you already tried wants that same detail, in writing. Evidence Evidence
Why this matters
- Sources cited, not yet graded
I read the VA criteria for Opzelura (ruxolitinib) cream in nonsegmental vitiligo. They require proof that topical steroids and topical calcineurin inhibitors, or phototherapy, failed or caused a bad reaction. The VA can skip that step when earlier treatment is unwise, unavailable, or not possible. Its criteria also require that a dermatologist prescribes or is involved.
Considerations
- Depends on you
Those are VA rules, not a private, Medicare or Medicaid standard, and I found no turnaround time or appeal step in them. Your photos also stay yours. Keeping them in one folder on your own phone, and deciding who ever sees them, is part of keeping the record.
Questions for your dermatologist
Looking at these dates, does my vitiligo look active to you right now?
Saving keeps this on your device and needs JavaScript, which is off in this browser.If ___ asks for a prior authorization, what would your office need from me in writing?
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Evidence behind this page
Sources
Each evidence badge opens the source and its limits. The full list stays available here.
- American Academy of DermatologyPatient education · Patient education, tier 5Independence not established
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports patient-facing context that skin which has lost its color can burn readily and that shade, clothing and labeled sunscreen use are broad protection options. It also supports that for some people a skin injury triggers new spots or patches, and it names cuts, scrapes and burns. The wound a tattoo makes can lead to the Koebner phenomenon, with new spots appearing about 10 to 14 days later. It supports that a tattoo added for pigment may not blend with natural skin color, that its color can eventually bleed, and that the vitiligo underneath can spread over time. It supports the page telling readers to avoid tanning, indoors and outdoors, because tanning increases the contrast between natural skin color and the light spots and patches. That is what it says makes vitiligo more noticeable. It supports that tanning beds, sun lamps and other indoor tanning devices are not safe alternatives to the sun. Like the sun, they can burn skin that has lost pigment and worsen vitiligo. It supports that a bad sunburn can worsen vitiligo, and that on a lighter skin tone untanned skin often makes the spots and patches less noticeable. It supports that self-tanners and skin dyes tend to last 3 to 5 days, against one day for makeup. It names dihydroxyacetone as the ingredient to look for, and says natural-looking results take practice. It supports that vitiligo increases the risk of some other diseases such as thyroid disease, and that a dermatologist can monitor for them.
What it does not support
The page acknowledges support from Incyte Dermatology, so it does not independently establish treatment efficacy. It does not establish a personalized sun plan, a product ranking or a treatment-day instruction. It gives no frequency for injury-related patches and no way to tell in advance who they happen to. It gives no measure of how much tanning changes contrast, no threshold for a bad sunburn, and no way to tell whether one person’s vitiligo will worsen. It compares no tanning device with prescribed narrowband UVB and establishes nothing about medical phototherapy. It names no product or brand for camouflage, self-tanner or skin dye.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- DermNet (A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand)Patient education · Patient education, tier 5Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports that a Wood lamp examination is a diagnostic test. Skin or hair is examined while exposed to the black light a Wood lamp emits. It supports that black light is invisible to the naked eye. It sits in the ultraviolet spectrum, at a wavelength just shorter than the colour violet. It supports that the lamp glows violet in a dark environment. That is because it also emits some light in the violet part of the spectrum. It supports that a traditional Wood lamp is a low-output mercury arc covered by a Wood filter. That filter is barium silicate and 9% nickel oxide. It supports that the lamp emits wavelength 320 to 450 nm, with a peak at 365 nm. It supports that a Baltimore physicist, Robert W. Wood, invented it in 1903. It supports that modern black light sources may be specially designed BLB fluorescent lamps. They may also be mercury vapour lamps, light-emitting diodes or incandescent lamps. It supports that fluorescent black light tubes carry a dark blue filter coating. That coating filters out most visible light. It supports that fluorescence is a coloured glow. It is seen when certain substances absorb black light and emit it again at a longer wavelength in the visible spectrum. It names collagen and porphyrins as such substances. It supports that items on the skin surface can also fluoresce. It names fabric, topical medications and soap residue. It supports that skin to be examined should ideally not have been recently washed. It should ideally not have had makeup, deodorant or moisturising cream applied. Those can fluoresce and cause a false positive result. It supports that room lights are turned off and the surroundings darkened completely. It supports that the examiner waits to adapt to the dark. The lamp is then held about 10 to 30 cm away and the skin examined for a few seconds. It states that the examination is painless and safe. It supports that normal healthy skin is slightly blue under the lamp. It shows white spots where skin is thickened, yellow where it is oily and purple where it is dehydrated. It supports that clothing lint often shines bright white. It supports that a Wood lamp is used to identify the extent of pigmented or depigmented patches, and to detect fluorescence. It supports that loss of pigmentation, giving vitiligo as its example, is one of the things a Wood lamp may reveal. It reports that use as identifying affected areas in light-skinned people. It supports that hypopigmented skin has sharper borders under black light. It supports that hypopigmented skin fluoresces bright blue-white, or sometimes yellowish green, due to accumulated biopterins. It supports that the black light emitted by a Wood lamp is harmless. It supports that the lamp does not emit short-wavelength ultraviolet B radiation at 290 to 320 nm. So it does not cause sunburn or otherwise damage healthy skin. It supports that a patient with extreme photosensitivity might develop a rash on skin exposed to black light. It adds that the examination is usually very brief, and unlikely to cause problems even in very photosensitive patients. It supports that it is prudent to ask the patient to close their eyes when the face is examined. It supports that nightclubs use a Wood lamp to check fluorescent re-entry stamps. That sits in a list of non-medical uses that also names law enforcement, banks and gemology.
What it does not support
It is a dermatology reference page, not a trial and not a measurement of any one person. Its statement that black light is harmless describes a medical Wood lamp used briefly at 10 to 30 cm. It measures no venue light fitting and no evening of exposure. It sets no safe length of time under any lamp. That statement also rests on the absence of ultraviolet B, which is what causes sunburn. It is not a finding about skin where pigment has been lost. It reports the vitiligo use as identifying affected areas in light-skinned people. It grades nothing about how visible a patch is to another person. It names no lighting product sold for a venue and measures no output from one. It puts ultraviolet B at 290 to 320 nm, where the World Health Organization guide registered here puts it at 280 to 315 nm. Nothing on it identifies a rash on a reader or directs the care of one. It says nothing about a course of narrowband UVB prescribed by a clinician. Its author line is dated August 2014 and the page records a last review of 11 July 2023, so parts of it are older than the revision date registered here.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- MedlinePlus, U.S. National Library of MedicinePatient education · Patient education, tier 5Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports that a Wood lamp examination is a test that uses ultraviolet light to look at the skin closely. It supports that Black light test and Ultraviolet light test are alternative names for the same examination. It supports that the test is usually done in a dermatologist’s office, and that you sit in a dark room for it. It supports that the doctor holds the lamp 4 to 5 inches, or 10 to 12.5 cm, from the skin to look for colour changes. It supports that you will have no discomfort during the test. It supports that no special steps are needed beforehand, beyond a doctor’s instruction about creams or medicines on the skin. It supports that the test is done to look for bacterial infections, fungal infections and porphyria. It supports that it is also done to look for skin colouring changes, naming vitiligo and some skin cancers. It supports that not all types of bacteria and fungi show up under the light. It supports that normally the skin will not shine under the ultraviolet light. It supports that the exam may help a doctor confirm a fungal or bacterial infection, or diagnose vitiligo. It supports that it may also help a doctor learn what is causing light or dark coloured spots on skin. It supports that washing the skin before the test may cause a false-negative result. It supports that a room that is not dark enough can change the result. It supports that other materials glow under the light. It names some deodorants, make-up, soaps and sometimes lint. It supports that the risk it lists is to the eye. It says not to look directly into the ultraviolet light, as the light may harm the eye.
What it does not support
It is a consumer medical encyclopedia entry, not a trial. It describes a brief examination in a clinician’s office. It measures nothing about a light fitting in a public place, and gives no length of time that is safe under any lamp. It publishes no wavelength and never explains why skin without pigment looks different under the light. It measures nothing about how visible a patch is to another person. It does not diagnose vitiligo on its own, and says only that the exam may help a doctor do so. It lists no risk to skin at all, which is an absence of a statement rather than a finding of safety. Its content is written and reviewed by A.D.A.M. for the National Library of Medicine, and its stated review date of 14 October 2024 is what fixes its currency.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- Frontiers in Medicine (Abdi P, Anthony MR, Farkouh C, Chan AR, Kooner A, Qureshi S, Maibach H)Systematic review · Clinical research, tier 2Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports that a Wood lamp is a handheld device. It emits long-wave ultraviolet light. It supports a range of 320 to 450 nm, with a peak at 365 nm. It supports that the lamp carries a magnifying lens. It supports that patches outlined under a Wood lamp were much more prominent. That led to finding new patches not seen in ordinary light. It also led to finding that known patches had spread. It supports that the review grades the method as low cost, painless and easy to use. It grades it as rapid, portable and non-radiative, with results in real time. It supports that the review grades four limits. The first is false negative results, above all in darker skin tones. The second is that the result depends on the operator. The third is that lighting can limit it. The fourth is that uneven skin colour makes the spread of pale skin hard to judge. It supports one further point, made in the review’s section on ultraviolet light photography. Vitiligo shows up well in those photographs because the skin fluoresces more. That is because the pigment that would sit over it is gone.
What it does not support
It is a systematic review of ways to measure and diagnose vitiligo in people who already have it. It is not a trial. It measures nothing on any one reader. Its Wood lamp material sits inside the section on ultraviolet light photography. There is no separate Wood lamp section. Its sentence about fluorescence and missing pigment is written about photography. So it is not a Wood lamp finding. It is not a statement about what in the skin makes the glow. It never names biopterins and does not settle that question. It describes a clinical exam. It measures no venue light fitting. It sets no length of time that is safe under any lamp. It carries no finding about harm to skin or eyes from a black light. So it supports no part of a safety conclusion. It measures nothing about how visible a patch is to another person. Its false negative limit in darker skin tones is a limit of the method. It is not a prediction about any reader.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- VA Pharmacy Benefits Management ServicesPayer policy · Regulatory / guideline, tier 1Independence not established
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports the VA's own rules for ruxolitinib cream in nonsegmental vitiligo. It requires proof that topical corticosteroids and topical calcineurin inhibitors, or phototherapy, failed or caused a bad reaction. An adequate trial is at least six months of use. The VA can skip this step if the prior treatment is unwise, unavailable, or not possible. Also supports the 10%-of-body-surface application limit and that a dermatologist must prescribe or be involved.
What it does not support
This is a VA-only policy, not a private, Medicare Part D, or Medicaid rule. It does not say what any other payer requires. It also gives no national step-therapy standard, and does not state turnaround time, appeal steps, or cost. It does not prove these rules stayed the same after June 2023. The VA's own document says it gets updated as new facts appear.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- MyVitiligoTeamPatient education · Patient education, tier 5Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports a solid-colored background for a comparable photo series. Black, green, or dark blue are named as ones that help skin stand out. Supports using the same artificial light in the same position each time, rather than sunlight. Supports holding the camera straight rather than tilted. Supports a distance of about 3 to 5 feet, held the same every time. Supports photographing a fixed list of body areas the same way every time. Supports using a ruler for scale and tagging each photo with its date.
What it does not support
Written and reviewed for tracking vitiligo, a different condition, not for psoriasis. Only the general camera technique - background, lighting, angle, distance, and framing - is used here; nothing about vitiligo itself is carried over. Does not establish that photo tracking changes any psoriasis outcome.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- Journal of the European Academy of Dermatology and VenereologyGuideline · Regulatory / guideline, tier 1Relevant relationship disclosed
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: The journal is the publisher. This label refers to extensive author relationships disclosed for the recommendation, not to the journal itself.
What this source supports
It supports current expert-consensus terminology, clinical assessment, disease-activity evaluation, treatment-goal discussion, and shared decision-making. Its modified assessment check list names where the patches are as a disease feature, and gives genital involvement as its own example. It records white hairs as an item of its own, apart from what the vitiligo has done in the past six months. Its classification table keeps mucosal vitiligo as a subtype, both across more than one site and at one site alone. It supports planning care around what is there to work with, and its example is hair that still has its color. It names stable vitiligo and active vitiligo as two different states that change the care plan. Its shared-decision steps ask what the patient wants from care. At the time it was written, one cream form of a newer drug type had just been approved. Pill forms of that same drug type were still being studied.
What it does not support
It is not independent comparative proof. It cannot diagnose a reader from a description or photograph. It gives no figure for genital involvement, and it does not name lichen sclerosus. It does not set out the Vitiligo European Task Force grading scale. It puts no figure on white hairs and predicts nothing for one person.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- British Journal of Dermatology (Eleftheriadou V, et al.)Guideline · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports the clinical history and assessment domains, evaluation of associated autoimmune conditions, its recommendation for thyroid function and antithyroid antibody screening, current classification context, treatment-option map, psychosocial assessment, medical photography and the limits of pediatric evidence. Its classification table defines mucosal vitiligo as the oral or genital mucosae. One mucosal site alone is filed as undetermined or unclassified. Its differential diagnosis table lists genital or extragenital lichen sclerosus among the conditions that can be mistaken for vitiligo. That table also lists eczema, psoriasis, lichen planus, pityriasis alba and piebaldism. It calls autoimmunity a contributor to the pathogenesis of vitiligo. It reports an earlier review finding a possible negative impact on intimacy and sexual functioning. It tells clinicians to discuss the psychosocial impact of living with the condition. R28 offers a skin camouflage visit to people who want one. R10 to R14 name potent or very potent topical steroids as the first choice, with a topical calcineurin-inhibitor cream as an option for the face. These are different creams with different proof behind them. R20 names narrowband UVB as the first light option. It says the skin often does better on the face and trunk than on hands and feet. It says there is not enough proof to use any one current pill alone for vitiligo that is not changing. R25 and Table 2 keep cell grafting for vitiligo that is not changing and did not respond to other care. They also say a doctor cannot always tell if the vitiligo has truly stopped changing.
What it does not support
It was designed for UK care and reviewed literature through May 2019; it does not establish a universal testing plan, prescribe an individual plan, or establish current US labeling or coverage. Its differential diagnosis table is a list, not a method a reader can apply to their own skin. It does not say how to tell any two of those conditions apart. It gives no figure for how often vitiligo affects genital skin.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.