Vitiligo

Vitiligo causes white patches on your skin.

It can also affect your eyes, mouth, and nose. It occurs when the cells that give your skin its color are destroyed. No one knows what destroys them. It is more common in people with autoimmune diseases, and it might run in families. It usually starts before age 40.

The white patches are more common where your skin is exposed to the sun. In some cases, the patches spread. Vitiligo can cause your hair to gray early. If you have dark skin, you may lose color inside your mouth.

Using sunscreen will help protect your skin, and cosmetics can cover up the patches. Treatments for vitiligo include medicines, light therapy, and surgery. Not every treatment is right for everyone. Many have side effects. Some take a long time. Some do not always work.

About 0.5 to 1 percent of the world’s population have vitiligo. The average age of onset is in the mid-twenties, but it can appear at any age. The disorder affects both sexes and all races equally; however, it is more noticeable in people with dark skin.

Vitiligo seems to be somewhat more common in people with certain autoimmune diseases, including hyperthyroidism, adrenocortical insufficiency, alopecia areata, and pernicious anemia . Scientists do not know the reason for the association between vitiligo and these autoimmune diseases. However, most people with vitiligo have no other autoimmune disease.

Vitiligo sometimes runs in families. Children whose parents have the disorder are more likely to develop vitiligo. However, most children will not get vitiligo even if a parent has it, and most people with vitiligo do not have a family history of the disorder.

Vitiligo appears to occur when immune cells destroy the cells that produce brown pigment (melanocytes). This destruction is thought to be due to an autoimmune problem, but the cause is unknown.

Vitiligo may appear at any age. There is an increased rate of the condition in some families. The condition affects about 1 out of every 100 people in the United States.

Flat areas of normal-feeling skin without any pigment appear suddenly or gradually. These areas have a darker border. The edges are well defined but irregular.

Vitiligo most often affects the face, elbows and knees, hands and feet, and genitals. It affects both sides of the body equally.

Vitiligo is more noticeable in darker-skinned people because of the contrast of white patches against dark skin.

No other skin changes occur.

Your health care provider can usually examine your skin to confirm the diagnosis.

Sometimes, a health care provider may use a Wood's light. This is a handheld ultraviolet light that causes the areas of skin with less pigment to glow bright white.

In some cases, a skin biopsy may be needed to rule out other causes of pigment loss. Your doctor may also perform blood tests to check the levels of thyroid or other hormones, and vitamin B12.

Vitiligo is difficult to treat.

Early treatment options include the following:
  • Phototherapy, a medical procedure in which your skin is carefully exposed to ultraviolet light. Phototherapy may be given alone, or after you take a drug that makes your skin sensitive to light. 
  • Medicines applied to the skin, such as corticosteroid creams or ointments, immunosuppressant creams or ointments , or topical drugs.
  • Skin may be moved (grafted) from normally pigmented areas and placed onto areas where there is pigment loss.
  • Several cover-up makeups or skin dyes can mask vitiligo. Ask your health care provider for the names of these products.

In extreme cases when most of the body is affected, the remaining skin that still has pigment may be depigmented. This is a permanent change that is used as a last resort.

It is important to remember that skin without pigment is at greater risk for sun damage. Be sure to apply a broad-spectrum (UVA and UVB), high-SPF sunscreen or sunblock and use appropriate safeguards against sun exposure. Sunscreen can also be helpful for making the condition less noticeable, because unaffected skin may not darken in the sun.

The course of vitiligo varies and is unpredictable. Some areas may regain normal pigment (coloring), but other new areas of pigment loss may appear. Skin that is repigmented may be slightly lighter or darker than the surrounding skin. Pigment loss may get worse over time.