Overview

Vitiligo (vit-ill-EYE-go) is a disorder that causes patches of skin to turn white. This happens when melanocytes (ma-LAN-o-sites), the cells that make pigment or color, are destroyed.

There is no cure for vitiligo, but treatment may be able to make skin tone appear more even. The white patches of skin usually spread over time, but for some people, they don’t. Nonsegmental vitiligo typically spreads, while segmental vitiligo does not. Doctors currently can’t predict whether your vitiligo will spread and, if so, how fast.

Some research suggests that people with vitiligo and their family members may have a greater risk of developing certain autoimmune diseases.

Who Gets

Anyone can get vitiligo, but it is most noticeable in people with dark skin. For most people with vitiligo, the white patches begin to appear when they are in their 20s.

Vitiligo seems to be more common in people who have a family history of the disorder or who have certain autoimmune diseases, including:

  • Hyperthyroidism.
  • Adrenocortical insufficiency.
  • Alopecia areata.
  • Pernicious anemia.

Most people with vitiligo do not have an autoimmune disease or a family history of the disorder, however.

Symptoms

The main symptom of vitiligo is patches of white or depigmented skin. The depigmented patches are most common on parts of your body exposed to the sun, including your hands, feet, arms, and face.  You may also see depigmented patches on and around your eyes, armpits, groin, navel, genitals, and rectum.

Vitiligo usually develops in one of these patterns:

  • Segmental (or unilateral) pattern, where the white patches are on only one side of your body.
  • Nonsegmental (or bilateral or generalized) pattern, where the white patches appear symmetrically on both sides of your body. This is the most common pattern.

You may also have patches of white or gray hair, white eyelashes, or white eyebrows. People with dark skin may have lighter areas inside their mouths. Some people with vitiligo get uveitis, inflammation of a part of the eye.

Causes

Doctors don’t know what causes vitiligo, but some think it may be an autoimmune disease – a type of condition where your body’s immune system starts attacking your own cells. Some people have reported that they developed vitiligo or their vitiligo got worse after sunburns or emotional distress, but researchers aren’t sure that’s what caused their vitiligo.

Diagnosis

To diagnose vitiligo, your doctor will probably look at your skin, examine you to rule out other illnesses, ask some questions, and do some tests.

Some questions your doctor might ask are:

  • Do any of your family members have vitiligo?
  • Do you or any of your family members have any autoimmune diseases?
  • Did you have a rash, sunburn, or other skin problem before the white patches appeared?
  • Did you have something stressful happen or did you have a physical illness?
  • Did your hair turn gray before age 35?
  • Are you sensitive to the sun?

Tests might include:

  • A biopsy, which means taking a small sample of your skin to be examined. Under a microscope, doctors can usually see a complete absence of melanocytes in the depigmented skin of a person with vitiligo.
  • Blood tests to check for autoimmune diseases.
  • An eye exam to check for uveitis, inflammation of part of the eye that sometimes occurs with vitiligo.

Treatment

Vitiligo is not usually medically harmful, but the white patches can cause emotional distress. Most treatments for vitiligo are designed to help restore color to the white patches of skin. For some people, treatment helps make the skin color look more even, but many treatments can have unwanted side effects. Treatments can take a long time, and sometimes they don’t work.

Medical treatments can include:

  • Medicines or medicated skin creams, such as corticosteroids, that may be able to return color to the white patches of skin. This is particularly effective in early stages of the disease.
  • Light or laser treatments.
  • A combination of ultraviolet light treatment and medicine known as psoralen photochemotherapy or psoralen and ultraviolet A (PUVA) therapy. This involves taking or applying the drug psoralen, which reacts with ultraviolet light to cause your skin to darken. With this type of therapy, it is very important to limit your exposure to sunlight.
  • Depigmentation, or removing color from dark areas of the skin so they match the white patches. This may be recommended for people who have vitiligo on more than half of their bodies. Depigmentation tends to be permanent, is time consuming, and will make you unusually sensitive to sunlight.
  • Tattooing small areas of skin.
  • Surgical techniques when topical creams and light therapy do not work. Surgery is typically not recommended for people who scar easily or develop keloids. 

Who Treats

A number of doctors can diagnose and treat vitiligo. These include:

  • Dermatologists, who treat skin problems.
  • Primary care physicians or internists.
  • Other specialists, such as opthamologists (who treat eye problems) may also provide care.

Living With

Health care professionals can recommend treatments for your vitiligo, but you can also take part in your own care.

  • Sunscreen can help protect your skin from long-term damage.
  • Cosmetics, such as self-tanning lotions or dyes, can cover depigmented patches.

Some people with vitiligo are upset or depressed about the changes in their appearance. Counseling and support can help you cope with the disorder.

  • Find a doctor who knows how to treat vitiligo. The doctor should also be a good listener and provide emotional support.
  • Learn about the disorder and treatments to help you make decisions about care.
  • Talk with other people who have vitiligo. A vitiligo group may help you find a support group in your area.
  • Your family and friends can also support you.

Research Progress

Much of the research that holds promise for understanding, treating, and possibly preventing vitiligo is supported by the NIAMS.

For example, researchers are looking at the immune response to understand the body’s natural mechanisms to control autoimmune diseases, which could be used to develop new treatment strategies. As well, studies are looking for genes that may contribute to vitiligo in several ethnic groups.

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