Vitiligo

Vitiligo is a skin disorder that results in the loss of skin pigmentation, leading to white or depigmented patches on the skin. It is a chronic and often unpredictable condition that can affect people of any age, gender, or ethnicity.

Vitiligo symptoms

The main symptom of vitiligo is flat, white spots or patches on your skin. The first white patch usually develops where the skin has been exposed to the sun. Vitiligo does not cause physical discomfort to your skin, such as itching.

Areas commonly affected by vitiligo

The areas most commonly affected by vitiligo include:

• The face and neck
• Hand
• Genitals.

The symptoms of vitiligo often appear on both sides of your body as symmetrical white patches. This is sometimes called bilateral, or generalised, vitiligo. Symmetrical patches can appear on areas such as:

• The backs of your hands
• Your arms
• Eyes
• Knees
• Elbows
• Feet.

Sometimes, vitiligo can develop on your scalp. The lack of melanin in your skin can cause the hair in the affected area to turn white or grey. If you have vitiligo, you may get a rash after you have been in the sun (photosensitivity). Sometimes the white patches may only affect one area of your body. This is known as unilateral, localised or segmental vitiligo. Unilateral vitiligo is less common than bilateral vitiligo although, in children, the symptoms of vitiligo usually affect only one part of the body. In rare cases, it is possible for vitiligo to affect your whole body. This is known as universal, or complete, vitiligo.

Causes of vitiligo

Although its cause is not fully understood, vitiligo is thought to be an autoimmune condition. This means that your immune system does not work properly. Instead of attacking foreign cells, such as bacteria, your immune system produces antibodies that attack your body’s own healthy cells and tissue. If you have vitiligo, it’s thought your immune system produces antibodies which destroy skin cells that make melanin. Vitiligo can be associated with other autoimmune conditions, such as hyperthyroidism (an overactive thyroid gland).

Occupational vitiligo: In a susceptible person, exposure to certain chemicals (in your job for example), could cause a reaction, and lead to white patches developing on your skin. This is sometimes called occupational, or contact, vitiligo.

Other causes: Vitiligo can run in families. About one in three people who have vitiligo also have a relative who is affected by the condition.

Who’s Affected

Vitiligo can affect people of any age, gender, or ethnicity. It is more common in people with darker skin, and it affects both men and women equally. The condition affects approximately 1% of the global population, and it can occur at any age, but it is most commonly diagnosed in people between the ages of 20 and 40.

Diagnosing vitiligo

A dermatologist or doctor can diagnose vitiligo by examining the affected skin and taking a medical history. The doctor may use a special lamp called a Wood’s lamp to help identify areas of depigmentation. In some cases, a skin biopsy may be necessary to confirm the diagnosis and rule out other skin conditions.

Vitiligo treatment

There is no known cure for vitiligo. However, treatment may help to improve your skin’s appearance by:

• restoring pigment, or colour, to your skin, and
• helping to control the spread of the condition.

Treatment for vitiligo is not always successful.

Treatment from your doctor

If you have new white patches on your skin that do not cover a large area, your doctor may prescribe a corticosteroid (steroid) cream. This can sometimes stop the spread of the patches, and may restore your original skin colour. Your doctor will tell you how to apply the cream to the patches and how much you should apply.

The strength of the steroid cream may vary, depending on where your white patches are. For example, your doctor may prescribe:

• a mild cream for patches on your face, or
• a stronger cream for patches on your upper body, arms or legs.

Initially, your doctor may advise you to use the cream for between four to six weeks. Steroid cream should only be used for a limited time because long-term use may cause side effects such as:

• streaks, or lines, in your skin (striae), or
• thinning of your skin (atrophy).

Monitoring the progress of your treatment

Your doctor will review the progress of your treatment regularly. They may ask to see you every six weeks in order to monitor your progress.

To assess whether your vitiligo is improving your doctor may:

• use a special ultraviolet lamp to examine your skin, or
• take photographs of your skin.

If your treatment is working and you don’t have any side effects, your doctor may recommend taking a break and then continuing with your treatment.

For example, they may suggest that you have a break from treatment for four weeks, then continue with another course of treatment for four weeks. Your progress will be reviewed again after this period.

Protection from the sun: When your skin is exposed to sunlight, it produces a pigment called melanin to help protect it from ultraviolet light. If you have vitiligo, sunburn is a real risk because of the lack of melanin in your skin. Always apply a high factor sun cream, with sun protection factor (SPF) 30 or above, to protect your skin from sunburn and long-term damage. This is particularly important if you have fair skin.

Protecting your skin from the sun will also minimise tanning, which will help to make your vitiligo much less noticeable.

Referral to a specialist

If the white patches are on visible parts of your body, such as your face, your doctor will probably refer you to a skin-care clinic or specialist for advice about skin camouflage.

Your doctor may also refer you to a dermatologist if, for example:

• treatment with steroids has been unsuccessful,
• the white patches cover a large area of your body, or
• the white patches cover the whole of your body (universal vitiligo), which is rare.

Your specialist may consider other types of treatment, such as those described below.

Skin camouflage

Skin camouflage involves applying coloured creams to your skin to help the white patches blend with the rest of your skin. The creams match your skin’s natural colour.

For advice about skin camouflage, your doctor may refer you to a dermatology clinic. You can also get skin camouflage cream that includes sun block, or sun protection factor (SPF).

Self-tanning lotion may also help to cover vitiligo. Some types can last for several days before you need to reapply them. Self-tanning lotion is available from most pharmacies.

Light therapy (phototherapy)

Treatment with light therapy may be used if the white patches cover a large part of your body. In almost half of all cases of vitiligo, light therapy works well and returns the original colour to the skin.

During light therapy, your skin is exposed to ultraviolet A (UVA) light from a special lamp, after you have had a medicine (psoralen) that makes your skin more sensitive to the light. You can take the medicine by mouth (orally), or you can add it to your bath water. This type of treatment is sometimes called PUVA (psoralen and ultraviolet A light).

PUVA can increase the risk of skin cancer because of the extra exposure to UVA rays. Therefore, it is not recommended for children or pregnant women.

Ultraviolet B (UVB) light is also sometimes used in light therapy.

Depigmentation

Doctors may recommend depigmentation for people who have vitiligo on more than 50% of their bodies.

During depigmentation, the unaffected skin is faded in order to remove its colour (pigment) and match the white areas. A special medicine is applied to the white patches twice a day, for a year. Depigmentation is permanent and cannot be reversed.

Skin grafting

Your doctor may consider using skin grafts if the white patches have stopped developing. This type of treatment is time consuming. It is not always successful, and has a risk of scarring.

During a skin graft, a surgeon will remove a thin layer of normal skin from one area of your body and attach it to the white area.

Other treatments

Sometimes, your doctor may recommend trying more than one treatment. For example, calcipotriol cream is sometimes used alongside light therapy, and tacrolimus or pimecrolimus creams are sometimes used with laser therapy.

Counselling and support groups

If you have vitiligo, you may find it helpful to speak to a psychologist, or join a vitiligo support group. This may help you to understand more about your condition, and to come to terms with your skin’s appearance.

Your doctor or healthcare provider may refer you to a psychologist, or a counsellor, who will be able to help you, or they may be able to give you information about support groups.

Complications

Vitiligo is a relatively benign condition that primarily affects the appearance of the skin. However, in rare cases, it can lead to complications such as:

• Sunburn and skin cancer: The loss of skin pigmentation can increase the risk of sunburn and skin cancer.
• Eye disorders: Some people with vitiligo may develop eye disorders, such as inflammation of the iris (iritis) or an increased risk of uveitis.
• Hearing loss: In rare cases, vitiligo can be associated with hearing loss.
• Psychological impact: Vitiligo can have a significant psychological impact on people, leading to depression, anxiety, and a decreased quality of life.

FAQs

Is vitiligo genetic?