Vitiligo is a medical condition affecting your skin’s color. When you have vitiligo, the cells that produce your skin color (also called pigment) are destroyed, and can no longer produce pigment. As a result, some of your skin loses its color in a process called depigmentation. The patches of lighter skin can appear anywhere on your body.
Only about one percent of the world’s population has vitiligo, according to the National Vitiligo Foundation Inc (NVFI). As many as 5 million Americans are affected by the disease; half of them are children and teens.
Vitiligo isn’t caused by a single factor such as age, race, or gender. The condition tends to run in families. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) estimates that 30 percent of people with vitiligo also have a family member with the disease. You are also more likely to develop the skin condition if you have an autoimmune disease such as:
- alopecia areata (baldness)
- pernicious anemia (inability to absorb vitamin B12)
- hyperthyroidism (an overactive thyroid)
- rheumatoid arthritis
- type 1 diabetes
In some people, emotional stress from a traumatic life event can trigger vitiligo. Physical factors such as severe sunburn may also play a role, but according to NIAMS, the scientific evidence is lacking on this point.
Three different types or patterns of vitiligo exist. You’ll lose skin pigment in different areas of your body according to the type of vitiligo you have. The most common type of vitiligo is called generalized pattern vitiligo. Symptoms of generalized pattern occur on both sides of your body in a widespread, symmetrical pattern. Segmental pattern vitiligo appears on only one side of your body, though it still might affect large patches of skin. Focal pattern is limited to smaller areas of depigmentation.
The primary symptom of vitiligo is white spots on the skin. Common areas of depigmentation include skin that is routinely exposed to the sun:
Body folds, such as the skin under your arms and the skin in your groin area, are also often affected by vitiligo. Your nostrils, the inside of your mouth, the areas surrounding your eyes, nipples, belly button, and genitals can also lose pigment. The patches can be large or small, and might stay in one area or spread across your body, depending on the location. Some people with vitiligo also have premature graying of the hair, and can lose the color of their eyebrows and facial hair too.
You might notice a rapid change in the color of your skin for a while, and then no changes at all. This is a normal development pattern for vitiligo.
In order to diagnose vitiligo, your doctor will take an extensive medical history and perform a physical exam. Be sure to report any events that could be contributing factors, such as recent sunburns, premature graying of your hair, or any autoimmune diseases you may have. Let your doctor know if anyone else in your family has vitiligo or other skin diseases. Samples of your skin and blood will be taken as part of the physical exam. Skin samples seen under a microscope can show if you still have pigment-producing cells in that area of your body. Blood tests can help diagnose other problems that are related to vitiligo, such as thyroid problems or anemia.
The treatment options for vitiligo vary according to the severity of your condition. If you’re in the early stages of the disease with limited patches of depigmentation, you are more likely to respond to steroid therapy than you would if your condition was advanced. Topical steroid creams that you rub into the affected areas of skin may be able to restore your normal skin color. Usually you’ll need at least three months of treatment before you’ll see if the therapy is effective. Phototherapy, combined with a medication called psoralen, is a more effective treatment method. Also called PUVA, phototherapy exposes you to UVA rays after applying the topical medication to your skin. This is the most effective treatment for vitiligo, according to NIAMS.
A third medical treatment for vitiligo is reserved for people who have white patches on at least half of their body. Depigmentation fades the rest of your skin to match the areas that have lost their natural color. You’ll use a medicine called monobenzyl ether of hydroquinone twice daily as a kind of skin-bleaching treatment. Depigmentation must be done very carefully, as it is permanent. The treatment can also cause side effects such as inflammation, itching, and dryness.
Even if you are undergoing medical treatment for vitiligo, the results can be slow. Some patients take matters into their own hands and use cosmetics to cover the discoloration of their skin. Foundation makeup and sunless tanning products matched to your natural skin tone can provide a seamless look for many social situations in which large portions of your skin are exposed.
When medical treatment fails to help restore your skin pigment, ask your doctor about surgical options. Three types of surgery are available to people with vitiligo:
- skin grafting: Your surgeon removes healthy, pigmented skin and transfers it to depigmented areas.
- melanocyte transplants: Your doctor removes pigment-producing cells called melanocytes and lets them grow in a lab. Then, the cells are transplanted to the depigmented areas of skin.
- micropigmentation: Depigmented areas of your lips are artificially re-pigmented with dyes.
Usually, surgery is reserved for people who have had vitiligo for more than three years, and whose conditions are stable and unchanged.
Vitiligo can be very noticeable to others, especially if you have dark skin. The disorder can be troubling from an emotional perspective, and may cause struggles with self-esteem. Support groups, in addition to conventional treatment, can be great outlets for vitiligo patients. These groups give patients the opportunity to express themselves and meet others with the same condition. Ask your doctor for a referral to counseling or a support group if you are having a hard time dealing with your vitiligo on an emotional level.
Vitiligo can’t be cured, but it can be managed effectively through a series of medical treatments and lifestyle adjustments. The NVFI reports that research for the skin disorder has increased in the last 10 years. Experimental treatments with promising results continue to give hope to people who are affected by this chronic skin condition.