What Is Vitiligo? Causes, Symptoms, and Treatments

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Have you noticed patches of your skin that have turned white or lost pigment? Do these areas of your skin seem to be getting bigger over time? If so, you may have vitiligo. Vitiligo is a condition where your skin loses pigmentation over time, usually irreversibly, and can affect any part of your body. If you think you have this condition, you can read more about the symptoms, diagnosis, and treatment of vitiligo below.

What Is Vitiligo?

Vitiligo is a long-term condition that causes areas of your skin to lose color (pigmentation), resulting in patches of lighter-colored or white skin that tend to grow bigger over time. It is not a contagious or life-threatening condition. While people of all skin colors can get vitiligo, it is more noticeable for people with black or brown skin.

Vitiligo can develop on any part of the body and varies from person to person in the size, location, and spread of skin patches. There are two main types of vitiligo based on how much of your skin is affected:

  • Generalized (non-segmental) vitiligo: loss of skin pigmentation on several areas all over the body, often appearing as symmetrical white patches on both sides of your body. This is the most common form of vitiligo, accounting for 9 out of 10 people with the condition. 
  • Segmental vitiligo: loss of skin pigmentation and the appearance of white patches. It is restricted to one area or one side of the body. This type is less common but usually develops earlier in life and is more common among children. 

Other more rare forms of vitiligo include:

  • Universal vitiligo: nearly all of your skin loses its pigmentation
  • Localized or focal vitiligo: only one or a few areas of the body are affected
  • Acrofacial vitiligo: your face and hands are affected as well as areas around body openings, such as your eyes, nose, and ears

Symptoms & Signs

Vitiligo can develop at any age, but symptoms usually appear before age 30. Symptoms can affect any area of skin on your body and the pigmentation of hair follicles or mucous membranes. Common signs and symptoms of vitiligo include:

  • Skin Changes: Skin changes generally start with the appearance of a pale patch of skin on your hands, forearms, feet, or face which gradually turns completely white. However, the patches can appear anywhere, often around skin creases such as armpits, groin, and genitals.
  • Hair Changes: Graying or white hair in areas where the skin has lost its pigmentation.
  • Mucous membrane Changes: Changes in the color of the skin tissue that lines the inside of your mouth and nose.

What Causes Vitiligo?

Melanocytes are skin cells that produce melanin, the natural chemical in your body which gives your skin, eyes, and hair its color. When these skin cells stop functioning or die, and there are no longer enough working to produce the necessary melanin in your skin, this results in patches of skin that lose their pigmentation and turn a milky-white color.

We do not fully understand what causes the loss of melanocytes from affected skin areas in the first place. Researchers believe that it is most likely due to one or a combination of the following factors:

  • Autoimmune disorder: When functioning normally, your autoimmune system works to defend your body from harmful viruses, bacteria, and infections. Vitiligo is most widely considered an autoimmune disorder, where the immune system accidentally attacks healthy cells such as melanocytes.
  • Genetic factors: Vitiligo sometimes runs in families. Around 1 in 5 people with vitiligo have at least one close relative who also has vitiligo. However, research indicates that variations in over 30 genes may be associated with an increased risk of developing vitiligo, and family inheritance of these genes is just one factor.
  • Environmental factors: Studies suggest that exposure to certain environmental factors such as physically or emotionally stressful events, skin damage from severe burns or cuts, or certain chemicals may trigger vitiligo in people with other predisposing factors.

Vitiligo Diagnosis

A doctor will be able to diagnose vitiligo after examining the affected areas of skin and asking you questions about your medical and family history, including:

  • history of vitiligo in your family
  • history of other autoimmune conditions in your family
  • any other injuries to the affected areas of skin
  • history of sun exposure – for example, whether tan or burn easily when in the sun and if you’ve had any recent or severe sunburn to the affected area
  • your skin’s response to any treatments you have tried already

Your doctor may also use a special lamp (known as a Wood’s Lamp) to shine ultraviolet light onto your skin, making the patches of white skin easier to see and help to distinguish vitiligo from other skin conditions. They may also confirm a vitiligo diagnosis by doing blood tests, checking your eyes, or having a sample of your skin observed under a microscope.

Treatments for Vitiligo

While there is no cure for vitiligo, and the white patches caused by vitiligo are usually permanent, treatment options are available to reduce their appearance and restore lost skin color. From simplest to more complex and invasive, common treatments include:

  • Camouflage therapy: A non-invasive approach to conceal small areas of the affected skin. This may include specially designed make-ups to help cover depigmented areas, hair dyes for affected hair patches, and sunscreens to help minimize tanning to limit the contrast between affected and normal skin. 
  • Medicated skin creams: Applying a corticosteroid cream to affected skin might restore some color. These medications are most effective when symptoms of vitiligo first begin. Side effects of corticosteroid creams include skin thinning and the appearance of streaks or lines on the skin. Your doctor may give you corticosteroid pills or injections if your condition progresses very quickly.
  • Light therapy: Exposing the skin to a specific kind of light called narrow-band ultraviolet B (UVB) light can stop or slow the progression of vitiligo. You’ll receive this treatment two or three times a week. It may take one to three months to see any improvements, and you may have to wait six months or longer to get the full effect. If you can’t go to a clinic for treatment, you can use handheld devices for light therapy at home. Side effects of light therapy include redness, itching, and burning.
  • Surgical procedures: There are also more invasive treatments, such as skin grafting. This is where small patches of your healthy skin are transferred to areas of your skin that have lost pigment. You can also get pigmentation therapy. Possible issues with these procedures include infection, scarring, a cobblestone appearance to the skin, spotty skin color, and failure of the treated area to recolor. 

Next Steps

Talk to your doctor if you notice white patches on your skin that seem to be growing bigger. If you have vitiligo, your doctor will discuss management and treatment options. While you can’t always avoid the spread of vitiligo over time, there are ways you can avoid damaging your skin:

  • Protect your skin from the sun and artificial sources of UV light. Use a broad-spectrum, water-resistant sunscreen with an SPF of at least 30 to prevent sunburn. Apply your sunscreen generously and reapply it at least every two hours. Stay in the shade as much as possible, wear clothing that protects your skin from the sun and minimize tanning.
  • Avoid any other unnecessary damage to your skin (including tattoos). A tattoo can damage your skin and trigger a new patch of vitiligo or a larger patch if you are trying to cover up an existing area of white skin. 

You can find more information about vitiligo in general, vitiligo research, and support groups for people with vitiligo here.

Resource Links:

  1. “Vitiligo” via Mayo Clinic
  2. “Vitiligo Basics” via NIH
  3. “Vitiligo” via MedlinePlus
  4. “Vitiligo” via NHS
  5. “Vitiligo” via Cleveland Clinic
  6. “Vitiligo Overview” via American Academy of Dermatology Association