Overview of Vitiligo
Vitiligo is a chronic (long-lasting) disorder that causes patches of skin to lose pigment or color. This happens when melanocytes – skin cells that make pigment – are attacked and destroyed, causing the skin to turn a milky-white color.
There are two types of vitiligo:
- Nonsegmental or generalized vitiligo is the most common type. It happens when the white patches appear symmetrically on both sides of your body, such as on both hands or both knees. This type of vitiligo can have rapid loss of color or pigment and tends to cover a large area.
- Segmental vitiligo is much less common and happens when the white patches are only on one segment or side of your body, such as a leg, one side of the face, or arm. This type of vitiligo often begins at an early age and progresses for about 1 to 2 years and then usually stops.
The cause of vitiligo is unknown, but research suggests that vitiligo may be an autoimmune disease. The autoimmune system works throughout your body to fight off and defend your body from viruses, bacteria, and infection. In people with autoimmune diseases, the immune cells attack the body’s own healthy tissues by mistake. People with vitiligo may be more likely to develop other autoimmune disorders.
A person with vitiligo occasionally may have family members who also have the disease. There is no cure for vitiligo, but treatment may help skin tone appear more even.
Who Gets Vitiligo?
Anyone can get vitiligo, and it can develop at any age. However, for many people with vitiligo, the white patches begin to appear before age 20, and can start in early childhood.
Vitiligo seems to be more common in people who have a family history of the disorder or who have certain autoimmune diseases, including:
Symptoms of Vitiligo
The main symptom of vitiligo is loss of natural color or pigment, called depigmentation. The depigmented patches can appear anywhere on your body and can affect:
- Skin, which develops milky-white patches, usually on the hands, feet, arms, and face. However, the patches can appear anywhere.
- Hair, which can turn white in areas where the skin is losing pigment. This can happen on the scalp, eyebrow, eyelash, and beard.
- Mucous membranes, such as the inside of your mouth or nose.
People with vitiligo can also develop:
- Low self-esteem or a poor self-image from concerns about appearance, which can affect quality of life.
- Uveitis, a general term that describes inflammation or swelling in the eye.
- Inflammation in the ear.
Causes of Vitiligo
The exact cause of vitiligo is not fully understood. Scientists believe that it may be an autoimmune disease in which the body’s immune system attacks and destroys the melanocytes. In addition, researchers continue to study how family history and genes may play a role in causing vitiligo.
Finally, sometimes an event – such as a sunburn, emotional distress, or exposure to a chemical – can trigger vitiligo or make it worse.
Diagnosis of Vitiligo
To diagnose vitiligo, your doctor will ask about your family history and perform a thorough physical exam. The exam may include a close evaluation of your skin. Sometimes doctors use a Wood’s lamp, also known as a black light, which is an ultraviolet light that the doctor shines on your skin. If you have vitiligo, the light makes your skin appear chalky.
Other tests can include:
- Blood tests to check for other autoimmune diseases.
- An eye exam to check for uveitis, an inflammation of part of the eye that sometimes occurs with vitiligo.
- A skin biopsy, which means taking a small sample of your skin to be examined under a microscope. Doctors can examine the tissue for the missing melanocytes seen in the depigmented skin of a person with vitiligo.
Treatment of Vitiligo
Most treatments for vitiligo focus on stopping the immune system from destroying the melanocytes and improving the skin’s appearance. In most cases, the goals of your treatment are to:
- Slow or stop the disease from progressing.
- Encourage the regrowth of melanocytes.
- Restore color to the white patches of skin, which can help the skin color look more even.
It’s important to remember that treatments may take time, and not everyone responds. In addition, the results from treatments can vary from one part of the body to another, and new patches may appear in the meantime. Sometimes, doctors will recommend more than one treatment to get the best results.
Treatments can include:
- Medicines or medicated skin creams, such as corticosteroids or a calcineurin inhibitor, which may be able to return color to the white patches of skin.
- Use of light (phototherapy) to help return color to the skin. There are several different forms of light therapy. Doctors may use light boxes to treat large areas of vitiligo and use laser treatments on more localized areas.
- Depigmentation, or removing color from dark areas of the skin so they match the white patches. Doctors usually recommend this treatment for people who have vitiligo on more than half of their bodies. Depigmentation tends to be permanent and can take more than a year to complete. As with other treatments, it is very important to limit exposure to sunlight during and after treatment.
- Dermatologists may consider surgical techniques for long-standing segmental vitiligo or vitiligo of any type for which other treatments do not work.
- Skin grafting involves taking pigmented skin from one area of the body and attaching it to an area with a vitiligo patch. Sometimes the area can have a cobblestone appearance, spotty color, or failure to recolor.
- Blister grafting involves using suction to create a blister on the pigmented skin. The doctor removes the tops of the blisters and grafts or attaches them to the area with the vitiligo.
- Newer surgical procedures are being studied and may be an option in select cases.
Surgery is typically not recommended when vitiligo is spreading or for people who scar easily or develop keloids, which are raised scars that grow larger than the wound that caused the scar.
Who Treats Vitiligo?
Health care providers who treat vitiligo include:
- Dermatologists, who specialize in diagnosing and treating disorders of the skin, hair, and nails.
- Primary care physicians, such as a family practitioner or internist.
- Other specialists, such as ophthalmologists (who treat eye problems) may also provide care.
Living With Vitiligo
Living with vitiligo can be hard. Some people with the disorder feel embarrassed, sad, ashamed, or upset about the changes in their appearance. Sometimes, this can lead to low self-esteem and depression. Seeking advice and help from a mental health professional can help you cope with the disorder and treat depression.
In addition to the treatments your doctor recommends, you can help manage the disease by:
- Protecting your skin from the sun. Use sunscreen and wear clothes to help protect your skin from sunburn and long-term damage.
- Wearing cosmetics, such as self-tanning lotions or dyes, to cover depigmented patches of skin. Talk to your doctor about which lotion or dye you should use.
- Finding a doctor who has experience treating people with vitiligo.
- Learning about the disorder and treatments to help you make decisions about care.
- Talking with other people who have vitiligo. Consider finding a vitiligo support group in your area or through an online community.
- Reaching out to family and friends for support.
Research Progress Related to Vitiligo
The NIAMS supports research to help treat and possibly prevent vitiligo. Researchers are looking at the immune response to understand the body’s natural mechanisms that trigger and control autoimmune diseases, which could be used to develop new treatment strategies. In addition, studies are looking for genes and other factors that may contribute to vitiligo and are exploring possible new treatments for the disease.