Vitiligo is a condition in which you lose the pigment of your skin. Pigment, or melanin, causes skin color and is produced by cells called “melanocytes.”
Most people with vitiligo lose pigment in patches of normally pigmented skin, which is replaced by flat, white patches with irregular borders. This loss of pigmentation can occur in small patches on one side of the body or in large areas covering over 50 percent of the body. These patches are usually areas of your body that are exposed to the sun, such as your:
However, your genitalia can also be affected.
Vitiligo can be treated but not cured. You’ll need to manage the disorder throughout your life. The National Vitiligo Foundation estimates that 0.5 to 1 percent of the general population has vitiligo.
The condition isn’t contagious, doesn’t cause pain, and isn’t medically dangerous. Vitiligo affects males and females of all races equally. The loss of pigment, called depigmentation, is more noticeable in people with dark skin.
What Causes Vitiligo?
The exact cause of vitiligo is unknown, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Researchers think that vitiligo could be an autoimmune response, meaning that the body attacks itself. In this case, your body destroys its own melanocytes so that the pigment is lost. Vitiligo also appears to be an inherited condition. Up to 30 percent of people who have vitiligo have a family member with the same condition.
Links exist between vitiligo and other autoimmune diseases, such as alopecia areata, hyperthyroidism, Addison’s Disease, and the genetic disease pernicious anemia.
Symptoms of Vitiligo
The main symptom of vitiligo is the absence of pigment on the skin. Three different patterns of depigmentation are possible:
- In a focal pattern, the loss of skin color appears in only a few small areas.
- In a segmental pattern, depigmentation occurs on one side of the body.
- In a generalized pattern, the loss of melanin occurs on both sides of the body in a symmetrical pattern.
The generalized pattern is the most common type of vitiligo. Depigmentation in any of the three patterns can appear on your:
The lining of the inside of your mouth may also lose color.
Premature graying of scalp and facial hair can also be a sign of vitiligo. This includes your eyebrows and eyelashes.
Your doctor will review your medical history and possibly test a skin sample to diagnose vitiligo. Family history of the condition and reports of sunburns or blistering are considered. According to the NIAMS, sun damage may trigger vitiligo symptoms in some patients. A skin biopsy can reveal the complete absence of pigment and may confirm the diagnosis.
Your doctor might also run blood tests to check your vitamin B-12 levels and thyroid function. An overactive thyroid and a deficiency of B-12 are often associated with vitiligo. Running these tests can help you get prompt treatment for any related conditions if needed.
Treatment and Management
Vitiligo is painless and benign. The goal of treatment is to restore pigment to your skin, which is cosmetic. Treating vitiligo is a long-term commitment. Most therapies don’t show results for several months. Treatments include the following:
Topical medications can be effective ways to repigment the white patches of skin. Topical steroid medications are used in children and adults. Steroids must be applied to the skin daily for at least three months before you can expect to see results. Steroid creams can have some adverse effects, including a thinning of the skin or streaks of color on the skin.
Another group of drugs called immunomodulators may also treat vitiligo. These are ointments that contain the active ingredient tacrolimus or pimecrolimus. According to the Mayo Clinic, people who have small areas of pigment loss on the face and neck usually see results with immunomodulators.
Ultraviolet light therapy can restore pigment in some people with vitiligo. Most often, you are required to take a medication called psoralen, which causes the skin to be more sensitive to the light treatment. Psoralen is available in both topical and oral forms. The combination of psoralen and UVA rays is called PUVA treatment. It darkens the light areas of your skin.
Since you’re more sensitive to sunlight when using psoralen, you should protect the rest of your body with sunscreen. You can get PUVA treatment several times per week in your doctor’s office.
When repigmentation of the white patches fails, depigmenting the rest of your body is another treatment option. Depigmentation is reserved for those who present with vitiligo on more than half of their body. The goal is to match your normal pigmented skin to the areas affected by vitiligo.
A medication called monobenzone is applied to your skin to lighten the pigmented areas. This topical medication can bleach the skin of other people who may come into direct contact with you. Therefore, skin-to-skin contact must be avoided for two hours after treatment.
Noninvasive management of vitiligo can include makeup and sunless tanners. Tanning doesn’t help restore pigment loss from vitiligo, according to the NIAMS. Tanning makes the difference between normal and depigmented skin tone more obvious. You should use sunscreen with UVA and UVB protection to protect your skin.
In severe cases, you may elect to have surgery to try to restore normal skin tone. Skin grafting takes healthy skin and places it in an area that has been affected by vitiligo. Such surgical procedures are possibilities for people whose vitiligo hasn’t improved despite several years of consistent treatment. The surgery is expensive, rarely covered by insurance, and can cause scarring.
Some people with vitiligo need help coping with their emotional response to having a chronic skin condition. Ask your doctor for a referral to a support group or mental health professional if you need support. Counselors and your peers can also provide support.