Vitiligo

What is vitiligo?

Vitiligo is a skin disorder in which smooth white areas (called macules or patches) appear on a person’s skin. The condition occurs when the body’s melanocytes (the cells that produce melanin, the chemical that gives skin its color, or pigmentation) are destroyed. In addition to the skin, vitiligo can affect the mucous membranes (the moist lining of the mouth, nose, genital, and rectal areas), the eyes, inner ears, and hair.

How does vitiligo progress?

Vitiligo usually begins with a few small white patches that may gradually spread over the body over the course of several months. Sometimes the patches continue to widen and spread, but usually they stay in the same place for years. The location of the macules shifts and changes over time, as certain areas of skin lose and regain their pigments.

What causes vitiligo?

Although the causes of vitiligo aren’t completely understood, there are a number of different theories:

• Autoimmune disorder—The affected person’s immune system may develop antibodies that destroy melanocytes.
• Genetic factors—Certain factors that may increase the chance of getting vitiligo can be inherited. About 30% of vitiligo cases run in families.
• Neurogenic factors—A substance that is toxic to melanocytes may be released at nerve endings in the skin.
• Self-destruction—A defect in the melanocytes causes them to destroy themselves.

Vitiligo may also be triggered by certain events, such as sunburns or emotional stress; however, this has not been proven. Because none of the explanations seem to completely account for the condition, it’s possible that a combination of these factors is responsible for vitiligo.

What problems are associated with vitiligo?

Although vitiligo is mainly a cosmetic condition, people with vitiligo may experience a variety of problems:

• Because they lack melanocytes, macules are more sensitive to sunlight than the rest of the skin, so they will burn rather than tan.
• People with vitiligo may have some abnormalities in their retinas (the inner layer of the eye that contains light-sensitive cells) and some variation of color in their irises (the colored part of the eye). In some cases, there is some inflammation of the retina or iris, but vision is usually not affected.
• People with vitiligo may be more likely to get other autoimmune diseases (in which the body’s immune system causes it to attack itself), such as hypothyroidism, diabetes, pernicious anemia, Addison’s disease, and alopecia areata.

What are the types of vitiligo?

There are several variations of vitiligo. The most common are:

• Marginal inflammatory vitiligo—The macules are surrounded by a red, raised border. Usually the border is seen several months after the initial onset of vitiligo.
• Trichrome vitiligo—An intermediate shade of color appears between the macule and the unaffected skin.

Vitiligo is either localized (restricted to one area, such as the hands or face) or generalized (macules appear in various places on the body).

How common is vitiligo?

Vitiligo occurs in about 1 to 2 percent of the United States’ and the world’s population. Vitiligo affects all races and genders equally; however, it is more visible in people with darker skin. Although vitiligo can develop in anyone at any age, it most commonly appears in people ages 10 to 30 years. Vitiligo rarely appears in the very young or very old.

How is vitiligo diagnosed?

Usually the white patches are easily visible on the skin. However, the doctor will ask about the patient’s family history to determine if anything else might be causing the symptoms. If the diagnosis is not certain, the doctor can test for other similar conditions such as chemical leukoderma (macules caused by contact with chemicals) and systemic lupus erythematosus (an immune system disorder that causes inflammation of connective tissue).

How is vitiligo treated?

There is no cure for vitiligo. Common treatments include:

• Using sunscreen with an SPF of 30 or higher. Also, the sunscreen should shield ultraviolet B light and ultraviolet A light (UVB and UVA).
• Using covering cosmetic creams such as Covermark or Dermablend
• Using hair dyes (if vitiligo affects the hair)
• Repigmentation therapy:
  -Corticosteroids—can be taken orally or topically (as a cream put on the skin). Results may take up to 3 months to be seen. The doctor will monitor the patient for any side effects, which occasionally include skin thinning or striae (lines or streaks on the skin).
  -Topical immunomodulators—These products are applied to the skin and may act to reverse vitiligo with regular treatment.
  -Psoralen photochemotherapy (also called psoralen and ultraviolet A therapy, or PUVA)—The drug psoralen is first taken orally or topically, then the patches are exposed to special lamps with ultraviolet A light. Potential side effects are severe sunburn and blistering.
• Depigmentation—The drug monobenzone is applied to pigmented patches of skin so that they match the macules. The main potential side effects are inflammation, redness, swelling, itching, and dry skin.
• Surgery:
  -Autologous (from the patient) skin grafts—Skin is taken from one part of the patient and used to cover another part. Possible complications include scarring, infection, or a failure to repigment.
  -Skin grafts using blisters—This is the same type of procedure as autologous skin grafts, except that blisters are created on the patient’s skin to be used for grafting. This reduces any scarring.
  -Micropigmentation—A type of tattooing that is usually applied to the lips of people affected by vitiligo.

Vitiligo can be psychologically disturbing, and has the ability to affect a person’s outlook and social interactions. The patient’s doctor may suggest that the patient receive counseling or attend a vitiligo support group.

What is the outlook for people with vitiligo?

About 10 to 20 percent of people who have vitiligo fully regain their skin color. People with the best chance of regaining skin color are those who are young, whose vitiligo reaches its peak in less than 6 months and is located mainly on the facial area. People who are less likely to regain their color are those who get vitiligo later in life on their lips and limbs.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/18/2005