What is vitiligo?

Vitiligo is a skin condition that causes a loss of pigment in patches on the skin. The condition is not contagious nor is it life threatening. The condition is characterized by the formation of smooth patches of skin that appear lighter than your normal skin tone or may even turn white. Vitiligo can occur anywhere on the body and even can affect the hair or inside of the mouth.  

People of all skin types and tones can develop vitiligo, but the condition is most visible in people with darker skin tones since the contrast of the pigmentless areas is more noticeable. Vitiligo is a common condition, affecting 0.5 to 1 percent of the worldwide population. This figure may be more since people can underreport the condition. While treatment for vitiligo is not necessary, some may prefer treatment to help relieve stress or social anxiety around the condition. 

What causes vitiligo?

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The main cause of vitiligo is the death or malfunction of pigment-producing cells, called melanocytes. Melanocytes work by producing melanin, which is the pigment you see in your skin, eyes, and hair. When these cells stop working or die altogether, the skin in these areas no longer produces the same pigment that exists all around the skin. Over time, the patches become lighter and can turn white. 

The cause of the melanocyte dysfunction is unknown. The cause may be related to the following: 

Immune system disorder: An autoimmune condition could signal an attack on healthy melanocytes, treating normal cells as a threat to the body. 

Family history and genetics: Vitiligo could run in the family or be linked to a genetic mutation that makes your risk higher of developing the condition. 

Environmental triggers or stress: Outside emotional or physical stressors could change how your body produces melanin. In addition, other trigger events like sunburn, skin trauma, or exposure to toxic chemicals could cause vitiligo to develop.

What are the types of vitiligo?

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Vitiligo can occur in different parts of the body and can occur as either macules or patches. Areas of vitiligo are macules if they measure less than 1 centimeter wide. If the areas are larger, they are called patches. Each type of vitiligo has their own characteristics that help tell them apart. 

Broadly, there are two types of vitiligo: segmental and non-segmental. Segmental vitiligo is not common and occurs in one area of the body at a younger age. This type of vitiligo usually lasts for a few years and then goes away. Non-segmental vitiligo occurs all over the body, often symmetrically across the center of the body. The patches will continue to develop over time and may recur on a cycle.  Non-segmental vitiligo has various subtypes that include the following: 

Generalized: Generalized vitiligo occurs all across the body. 

Mucosal: This type of vitiligo occurs in the mucous membranes of the mouth and/or genitals. 

Focal: This rarer type of vitiligo affects a small area and does not spread over time. 

Trichome: Trichome is characterized by a bullseye-like ring of discoloration. 

Acrofacial: Acrofacial vitiligo appears on the face, hands, and around the eyes, nose, and ears. 

Universal: Universal vitiligo affects nearly 80% of your body and leaves those areas without pigment. 

What are symptoms of vitiligo?

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The main symptoms of vitiligo are the discoloration of the skin and appearance of patches around the body. The loss of pigment typically starts on the hands and face. Before the skin loses pigment, the hair on your scalp, eyelashes, eyebrows, or bear may begin to whiten or gray. The onset of symptoms typically starts before age 30. 

Symptoms of vitiligo can appear anywhere on the body, depending on the type of the condition you have. The progression of the condition depends on the individual and the type of vitiligo. In some cases, the vitiligo patches stop forming on their own without any treatment. Other cases of vitiligo continue to spread until most of the skin is impacted while some people will get their pigment back over time.

Are there risk factors or groups for vitiligo?

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Vitiligo affects all types of people equally. While the condition is more visible in people with darker skin tones, people of all skin tones develop the condition. Vitiligo is most common before age 30, but the condition can develop at older ages, too. 

Since the cause of vitiligo is still unknown, the following risk factors may increase your chances of developing the condition. Your risk for developing vitiligo might be higher if you have specific autoimmune conditions. Immune disorder that may put you at risk include:

  • Anemia
  • Type 1 Diabetes
  • Addison’s disease
  • Lupus 
  • Thyroid disease
  • Psoriasis 
  • Rheumatoid arthritis 

In addition to autoimmune conditions, a family history of vitiligo may increase the likelihood of developing the condition. Regular exposure to environmental and stress triggers of vitiligo could put you at a higher risk as well. 

Vitiligo is so common that even if you do not have these risk factors, you can still develop the condition. Similarly, you may have one or more of the listed risk factors and never have vitiligo. 

How is vitiligo diagnosed?

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An accurate vitiligo diagnosis is essential since vitiligo may indicate an autoimmune deficiency, which can signal or lead to other more serious immune system conditions. To diagnose vitiligo, your health care provider will do a physical examination of your skin, ask about your symptoms, and review your health history. Your doctor may be able to confirm a diagnosis with these measures, but sometimes vitiligo can be hard to detect. 

Because vitiligo occasionally does not appear on the skin in regular daylight, your doctor may use a special lamp called a Wood’s lamp to view the skin under different light. A Wood’s lamp applies UV light to the skin with all other lights off to illuminate areas of vitiligo on the skin.  

If after a more thorough exam and medical history review, your doctor is still unable to confirm a diagnosis, they may also evaluate your skin using a skin biopsy or blood tests. These tests can help detect other possible immune disorders along with a vitiligo diagnosis. 

How is vitiligo treated?

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Vitiligo has no cure, but there are treatments available that may add pigment back to the skin or prevent new pigment loss. The right treatment option will depend on how much of the skin is affected by vitiligo, where the patches are, how fast the condition is progressing, and how old you are. Any treatment plan will take time to see if it is effective. In addition, you may need to take a trial and error approach and try new treatments if some do not work. 

Treatment plans may work for a while, but you may notice new patches appear or old ones that come back. The main forms of vitiligo treatment are medications, light-based therapies, surgery, and counseling. Each form of treatment has its own pros, cons, and risks. Be sure to fully discuss each treatment with your doctor before deciding on the right one for you. 

Medications: Medications are used to help restore pigment to the skin, but they cannot stop the progression of vitiligo. Doctors will sometimes use medications in combination with light therapy as a treatment option. 

Corticosteroids: These medicines control inflammation and are most effective in the early stages of the condition. Corticosteroids take time to see changes and could cause skin thinning or the appearance of lines on the skin. 

Calcineurin inhibitors: This medicated ointment works well for people with small areas of vitiligo. Calcineurin inhibitors do carry a risk of lymphoma and skin cancer. 

Therapies: Therapies can stop the progression of vitiligo or alter the skin’s pigment. It is common to combine light and medication therapies, but the combination comes with the possible risk of developing skin cancer. 

Light therapy: Light therapy in the form of ultraviolet B rays (UVB) slows the progression of active vitiligo. Therapy happens across regular sessions and takes 1 to 3 weeks for results to show. Light therapy can cause redness, itching, and burning, but these effects tend to clear a short amount of time after treatment. 

Depigmentation therapy: This therapy involves removing the remaining color of the skin. People opt for this treatment if the vitiligo is already widespread or if other treatment options have failed. This treatment applies to unaffected skin to lighten the skin to better match the discolored areas. Typically, you apply this therapy twice a day for a course of nine months. Side effects include redness, itching, dry skin, and swelling. This treatment is permanent. 

Surgery: Surgeries are another option for people who have exhausted other treatment options. Surgeries work by restoring color and evening out skin tone. Surgeries are not beneficial for those who have quickly spreading vitiligo or who do not heal well and scar easily. 

Skin grafting: In this procedure, your doctor transfers sections of healthy skin to areas that have lost pigment. This treatment might scar but is good for small areas of vitiligo. 

Blister grafting: Doctors use this treatment to create a blister on healthy skin and use a graft of the blister to apply to skin without pigment. The trauma to the skin could cause scarring or even trigger a new vitiligo patch to form. 

Counseling: Counseling can be an effective treatment to learn how to cope with vitiligo and learn to live with the condition. 

Should you see a doctor for vitiligo?

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You should see a doctor for vitiligo if you begin to notice your skin or hair lose coloring. Early treatments may be able to stop or slow the progression of the condition and restore pigment. Contact your doctor if pigment loss is rapid, if the depigmentation spreads to a large area, or if pigment loss is affecting your mental health.

What is the outlook for people living with vitiligo?

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Vitiligo is non-life threatening and does not require any treatment. The outlook for people living with vitiligo is positive. While it is hard to predict if your skin will restore pigment, vitiligo should not have a great impact on your daily life.