Vitiligo

What is vitiligo?

Vitiligo (pronounced “vit-il-EYE-go”) is a skin condition that causes your skin to lose its color or pigment. This causes your skin to appear lighter than your natural skin tone or turn white. Areas of your skin that lose their pigment are called macules if they’re less than 1 centimeter wide, or patches if they’re larger than 1 centimeter. If you have vitiligo on a part of your body that has hair, your hair may turn white or silver.

The condition occurs when your body’s immune system destroys melanocytes. Melanocytes are skin cells that produce melanin, the chemical that gives skin its color, or pigmentation.

Who does vitiligo affect?

Vitiligo affects all races and sexes equally. It’s more visible in people with darker skin tones. Although vitiligo can develop in anyone at any age, macules or patches usually become apparent before age 30.

You might be at a higher risk of developing vitiligo if you have certain autoimmune conditions like:

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

How common is vitiligo?

Vitiligo occurs in over 1% of the population throughout the world.

How does vitiligo start and progress?

Vitiligo usually starts with a few small white macules or patches that may gradually spread over your body. Vitiligo typically begins on your hands, forearms, feet and face, but can develop on any part of your body, including your mucous membranes (the moist lining of your mouth, nose, genital and rectal areas), your eyes and inner ears.

Sometimes, larger patches continue to widen and spread, but they usually stay in the same place for years. The location of smaller macules shifts and changes over time, as certain areas of skin lose and regain their pigment.

The amount of affected skin varies for each person diagnosed with vitiligo. Some people experience a few depigmented areas, while others have a widespread loss of skin color.

What are the types of vitiligo?

Types of vitiligo include:

• Generalized: This is the most common type of vitiligo that causes macules to appear in various places on your body.
• Segmental: This type only affects one side of your body or one area, such as your hands or face.
• Mucosal: Mucosal vitiligo affects mucous membranes of your mouth and/or genitals.
• Focal: Focal vitiligo is a rare type where the macules develop in a small area and don’t spread in a certain pattern within one to two years.
• Trichome: This type causes a bullseye with a white or colorless center, then an area of lighter pigmentation, and an area of your natural skin tone.
• Universal: This rare type of vitiligo causes more than 80% of your skin to not have pigment.

What are the symptoms of vitiligo?

Signs and symptoms of vitiligo include:

• Patches of skin or mucous membranes that lose color. These can appear white or lighter than your natural skin tone.
• Patches of hair on your body turn silver, gray or white.

Symptoms can be mild and only affect a small area of your body or severe and affect a large area of your skin. Some people with vitiligo experience itchy skin before depigmentation starts.

Where will I have symptoms of vitiligo?

Symptoms of vitiligo can appear anywhere on the skin of your body. The most common places to have symptoms of vitiligo include on your:

• Hands.
• Feet.
• Arms.
• Face.
• Mucous membranes (inside of your mouth, lips and nose).
• Genitals (penis).

What causes vitiligo?

A lack of pigment in your skin (melanin) causes vitiligo. The reason why this happens is unknown. Research suggests vitiligo could be the result of:

• An autoimmune condition: Your immune system mistakes healthy cells (melanocytes) as foreign invaders like bacteria that can cause harm to your body. This makes your immune system overreact and develop antibodies to destroy your melanocytes.
• Genetic changes: A genetic mutation or a change to your body’s DNA can affect how your melanocytes function. There are over 30 genes that can increase your risk of developing vitiligo.
• Stress: The amount of pigment your melanocyte cells produce may change if you experience frequent emotional stress or physical stress on your body, especially after an injury.
• Environmental triggers: Factors like ultraviolet radiation and toxic chemical exposure can affect how your melanocyte cells function.

Is vitiligo genetic?

While research is ongoing to learn more about the causes of vitiligo, studies indicate that about 30% of vitiligo cases are genetic. This means that the condition is hereditary and you could potentially inherit vitiligo from your biological family. Several possible genetic mutations affect how melanocyte cells function. If a genetic mutation targets the cells that give your skin pigment, you’ll experience symptoms of vitiligo.

Is vitiligo painful?

No, vitiligo isn’t painful. However, you can get painful sunburns on lighter patches of skin affected by vitiligo. It’s important to protect yourself against the sun with measures like using sunscreen, staying out of the sun during the hours that it’s strongest and wearing protective clothing.

Does vitiligo cause complications?

Although vitiligo is mainly a cosmetic condition, vitiligo may cause:

• Sensitive skin: Macules and patches lack melanocytes, so your skin can be more sensitive to sunlight than the rest of your skin. This can cause your skin to quickly burn instead of tanning.
• Eye abnormalities: People with vitiligo may have some abnormalities in their retinas (the inner layer of your eye that contains light-sensitive cells) and some variation of color in their irises (the colored part of your eye). In some cases, there’s inflammation of the retina or iris, but vision usually isn’t affected.
• Predisposition to autoimmune conditions: People with vitiligo may be more likely to get other autoimmune conditions that affect how their body’s immune system functions. Common autoimmune conditions include hypothyroidism, diabetes and anemia.
• Emotional challenges: People with vitiligo may feel embarrassed about the way their skin looks. Some people diagnosed with vitiligo develop low self-esteem. This could cause anxiety or depression and make someone want to isolate themselves or avoid social situations. If this happens, you should talk to your healthcare provider, a mental health professional or your family and friends.

How is vitiligo diagnosed?

A visual examination by a healthcare provider usually leads to an accurate diagnosis of vitiligo. Your provider may use a Wood’s lamp to look at your skin. This lamp uses an ultraviolet (UV) light that shines onto your skin to help your provider differentiate vitiligo from other skin conditions. In addition, your provider may ask you questions about your medical history and family medical history.

What other conditions look like vitiligo?

There are other conditions that make your skin change or lose pigmentation, including:

• Chemical leukoderma: Exposure to some industrial chemicals causes damage to skin cells, resulting in linear or splotchy white areas of skin.
• Tinea versicolor: This yeast infection can create dark spots that show on light skin, or light spots that show on darker skin.
• Albinism: This genetic condition means that you have lower levels of melanin in your skin, hair and/or eyes.
• Pityriasis alba: This condition starts with red and scaly areas of skin, which fade into scaly lighter patches of skin.

How is vitiligo treated?

Treatment for vitiligo isn’t necessary, as the condition isn’t harmful to your body and is only cosmetic. If you have widespread vitiligo or your physical symptoms affect your emotional well-being, your healthcare provider can help you find a treatment option to create a uniform skin tone by either restoring color (repigmentation) or eliminating the remaining color (depigmentation) in your skin. Common treatments for vitiligo include:

• Medications.
• Light therapy.
• Depigmentation therapy.
• Surgery.
• Counseling.

Medications

There isn’t a specific medication to stop vitiligo from affecting your skin but there are certain drugs that can slow the speed of pigmentation loss, help melanocytes regrow or bring color back to your skin. Medications to treat vitiligo could include:

• Corticosteroids.
• Topical Janus kinase inhibitors (ruxolitinib).
• Calcineurin inhibitors.

Light therapy

Light therapy or phototherapy is the treatment to help return color to your skin. Your provider will use light boxes, ultraviolet B (UVB) lights or medical-grade lasers directed at your skin for a short amount of time. It can take several light therapy sessions to see results on your skin.

Combining oral psoralen medication and ultraviolet A light (PUVA) treats large areas of skin with vitiligo. This treatment is effective for people with vitiligo on their head, neck, trunk, upper arms and legs.

Depigmentation therapy

Depigmentation therapy removes the color of your natural skin tone to match areas of your skin affected with vitiligo. Depigmentation therapy uses the drug monobenzone. You can apply this medication to pigmented patches of your skin. This will turn your skin white to match the areas of your skin with vitiligo.

Surgery

Surgery is a treatment option for people diagnosed with vitiligo. Surgical treatment could include:

• Skin grafts: Skin is taken from one part of your body and used to cover another part. Possible complications include scarring, infection or a failure to repigment. This might also be called mini grafting.
• Blister grafting: Blister grafting uses suction to create a blister on your skin and your provider will then remove the top of the blister to attach it to an area of your skin affected by vitiligo.

Your healthcare provider might not recommend surgery if you:

• Have quickly spreading vitiligo.
• Scar easily.
• Develop raised scars that grow larger than a wound (keloids).

Counseling

Some people diagnosed with vitiligo find counseling or visiting a mental health professional beneficial to help improve their self-esteem, anxiety or depression that can be associated with changes to their skin. Vitiligo can cause psychological distress and can affect a person’s outlook and social interactions. If this happens, your caregiver may suggest that you meet with a counselor or attend a support group.

How can I prevent vitiligo?

As there could be several causes of vitiligo, there’s no known way to prevent it. You can reduce your risk of developing vitiligo by:

• Practicing safe sun exposure habits.
• Taking care of your skin by using a moisturizer daily.
• Avoiding stress or injury to your body.
• Managing any underlying autoimmune conditions.

What can I expect if I have vitiligo?

Vitiligo affects your appearance and can affect how you feel about your skin in social situations. Many people find comfort in speaking with a mental health professional to help them feel more confident and build their self-esteem.

There’s no cure for vitiligo but if you’d like to get treatment, your healthcare provider will help you choose the treatment that’s right for you and your skin.

Will my natural skin color return with vitiligo?

About 10% to 20% of people who have vitiligo fully regain their skin color. This is most common among people who:

• Receive an early diagnosis before age 20.
• Experience the peak of the condition spreading within six months or less.
• Have symptoms mainly in their facial area.

It’s less likely that you’ll regain your pigment if you:

• Develop vitiligo symptoms after age 20.
• Have symptoms on your lips, limbs or hands.

How do I hide vitiligo?

If you’re uncomfortable with how vitiligo looks on your skin, you can hide macules or patches at home by:

• Using sunscreen with an SPF of 30 or higher. The use of sunscreens minimizes tanning and limits the contrast between affected and normal skin.
• Wearing makeup to camouflage depigmented areas.
• Dying your hair with hair dye to help it blend in with unaffected hair on your head.
• Getting micropigmentation, which is a tattoo over your vitiligo spots. It acts as permanent makeup to hide symptoms of the condition.

Is vitiligo contagious?

No. Vitiligo isn’t contagious. It doesn’t spread from person to person through physical contact.

When should I see my healthcare provider?

Contact your healthcare provider if:

• Your skin loses pigmentation or color rapidly.
• Depigmentation spreads to a large area of your body.
• The changes to your skin affect your mental health and well-being.

What questions should I ask my doctor?

• What type of vitiligo do I have?
• Will my skin get its pigment back?
• How do I protect myself from the sun?
• What treatment options are best for my skin?
• Will my future children inherit this condition?

What’s the difference between tinea versicolor and vitiligo?

Tinea versicolor and vitiligo are different conditions that affect the pigment of your skin. Tinea versicolor is a fungal infection that causes your skin to develop white, yellow, red, pink or brown spots. Vitiligo is an autoimmune condition where you lose pigment. It causes your skin to turn lighter than your natural skin tone or white.

Is piebaldism the same as vitiligo?

No. Both conditions cause white or light patches of skin or hair. Piebaldism occurs when a portion of your skin doesn’t have melanocytes, which are cells that produce pigment (melanin). You’re born with piebaldism. Vitiligo occurs when your body has melanocytes, but they’re destroyed. You develop vitiligo during your lifetime.

A note from Cleveland Clinic

Vitiligo is a condition that causes cosmetic changes to your skin. It doesn’t need treatment because it isn’t dangerous. But it’s common for vitiligo skin changes to affect self-esteem and make people feel insecure or uncomfortable. Reach out to your healthcare provider to discuss how your physical appearance affects your mental health. There’s no cure for vitiligo, but treatment is available to help you feel more comfortable.