What Are the Types of Vitiligo?

Vitiligo is a chronic condition that causes patches of your skin to lose pigmentation or color. The exact cause of this condition is unknown, but its believed to be a type of autoimmune disorder.

Vitiligo usually appears between the ages of 5 and 10, with roughly 11% of pediatric cases developing before age 2. When it develops in adults, vitiligo usually appears between the ages of 10 and 30, and up to 80% of adult cases develop before age 30.

This article will review the different types and subtypes of vitiligo, what symptoms you can expect, and how this condition is treated.

Symptoms

The primary symptom of vitiligo is the loss of skin coloring in patchy areas around your body. This loss of natural color is called depigmentation and can appear in a few different ways:

• On the skin, vitiligo can appear as milky-white patches that can show up anywhere but are most common on the hands, feet, arms, or face.
• Your hair may also turn white over areas of depigmentation on your skin. This applies to the hair on your head, as well as hair in areas like your eyebrows, eyelashes, or even a beard.
• Vitiligo can also appear on mucous membranes like the inside of your mouth or nose.
  

Vitiligo can also lead to certain inflammatory conditions like swelling in the ear or the eyes (uveitis).

What Are the Different Types of Vitiligo?

Vitiligo is divided into types based on how and where areas of depigmentation appear.

Segmental

This type of vitiligo is uncommon and usually begins at an early age. With segmental vitiligo, loss of skin color develops in patches on just one area of your body. This can be one leg, one side of your face, or several areas on just one side of your body. Hair loss over areas of discoloration occurs in about half the people with this form of vitiligo. Segmental vitiligo is also sometimes called unilateral vitiligo.

This type of vitiligo usually progresses for about a year or two after it makes an appearance and then stops.

Non-Segmental Vitiligo

Non-segmental vitiligo is also known as generalized vitiligo or bilateral vitiligo, and it's the most common form of this condition. With this type, depigmented patches appear symmetrically on both sides of your body. For example, they can appear as matching spots on both legs or both arms.

With non-segmental vitiligo, the color loss is rapid and tends to be quite widespread covering large sections of your body. In some cases, this type of vitiligo can progress and then stop for a time, switching through an on-again, off-again cycle.

Subtypes 

Though vitiligo is split into types based on where discoloration appears, there are also subtypes for describing how much of your skin is affected.

Local

With localized vitiligo, only one or a few areas of depigmentation develop, and they are limited to just a few places on the body.

Generalized

Generalized vitiligo is the most common subtype. With this form of vitiligo, scattered patches of depigmentation are usually scattered across the body.

Universal

Universal is the most severe subtype of vitiligo. With this level of disease, almost all of your skin pigmentation is gone and the majority of your skin is depigmented. This level of vitiligo is the most extensive but also rare.

What Other Conditions Are Mistaken for Vitiligo?

Skin coloring can appear to change or become uneven for a number of reasons, so there are several other conditions that can be confused for vitiligo. Your doctor or dermatologist may check for these conditions before confirming a diagnosis of vitiligo, and you may hear these conditions referred to as a differential diagnosis.

Some conditions commonly confused for vitiligo include:

• Pityriasis alba (PA)
• Tuberous sclerosis complex (ash-leaf macules)
  
• Tinea versicolor
• Pityrosporum folliculitis
  
• Tinea capitis
• Erythrasma
• Pseudomonas
• Acne
• Porphyria cutanea tarda
  
• Nevus depigmentosus
  
• Nevus anemicus
• Idiopathic guttate hypomelanosis
  
• Piebaldism
  
• Progressive macular hypomelanosis
  
• Melasma
• Corneal abrasions
• Solar lentigo/lentigines
  

Is It Inherited?

The exact cause of vitiligo is unclear, and variations in more than 30 different genes have been linked to the condition. Environmental factors, genetics, stress, exposure to UV radiation, and certain chemicals are all suspected to play a role in the development of vitiligo. Only about one-fifth of cases appear to run in families. Although it's not impossible, a pattern of inheritance for vitiligo hasn't been confirmed due to the many factors involved in the appearance of vitiligo.

How to Treat Vitiligo

There are several options for treating vitiligo. It's important to take into account your preferences and treatment goals, your overall health, how much of your body is affected, and where on your body you have vitiligo.

No Treatment

Because there is really no dangerous impact on your physical health from vitiligo, some people choose not to use any medical treatment at all. Instead, you may opt for cosmetics to camouflage depigmented areas. These may include self-tanners and makeup.

Though this "treatment" may help to address the toll this condition can take on your self-image, keep in mind that you must apply makeup and other cosmetics carefully and regularly to get an even, natural-looking result.

Topical Medications

Topical medications can add color to the skin or calm inflammation. The most common topical medication for vitiligo is a strong topical corticosteroid, but even this treatment can take four to six months to restore even some color—and that only happens for about half of the people who use it.

Opzelura (ruxolitinib) is a topical medication approved by the Food and Drug Administration (FDA) to treat eczema and vitiligo. This medication is a Janus kinase (JAK) inhibitor for preventing inflammation.

Keep in mind that corticosteroids carry side effects, like making your skin thinner and more delicate. For this reason, it is only for small areas, and not all varieties of corticosteroids are for your face. This medication option is most effective in people with darker skin tones and is least effective on the hands and feet.

Light Therapy

Light therapy can take several forms and help restore color to your skin in depigmented areas. These treatments can be time-consuming, and results don't usually last long if you stop treatment.

Surgery

Surgery is an option for adults whose vitiligo has not changed for at least six months. Though this option is highly effective, it also carries a number of risks like scarring and infection.

Depigmentation

This therapy is uncommon but can even skin color out by removing pigmentation from areas of the skin that vitiligo has not already impacted. This treatment is usually for people who have very little natural pigmentation left in their skin. Fully completing this therapy can take one to four years.

Summary

Vitiligo is a chronic skin condition that sometimes runs in families but can have several causes. People with this condition are generally healthy, and most effects are superficial or cosmetic. In some cases, people with vitiligo have other autoimmune diseases, as well.

There are several ways to treat vitiligo, including topical medications or light therapy, based on your individual condition and preferences.

A Word From Verywell

Your skin is the largest and most visible organ on your body, so dermatologic conditions often create stress and can be difficult for your self-image. There are few symptoms if any beyond appearance with vitiligo, though, and your doctor can help you either cosmetically or medically treat the condition depending on the severity. For some people, the condition progresses for a time and then goes through periods of stability.

Talk to your doctor if you are experiencing other symptoms with your vitiligo or if you need help addressing this and other skin conditions.