How Vitiligo Is Diagnosed

A vitiligo diagnosis typically involves a review of your symptoms and medical history, a physical examination of the skin, and, potentially, a skin biopsy or blood work.

A diagnosis from a dermatologist (a doctor who specializes in skin, hair, and nails) is essential for treating the condition and preventing related health risks.

You might also need to be evaluated for other health issues. Research has shown that you are more likely to have other autoimmune diseases when you have vitiligo.

Learn more about how vitiligo is diagnosed and ways to check your skin at home.

Self-Checks

There are no at-home tests available to diagnose vitiligo. However, you can do a general self-check of your skin and look for patchy or widespread loss of pigmentation (the coloring of your skin, hair, and eyes).

The main symptom of vitiligo is white or lighter patches on the skin. These changes are clearly visible. Keeping an eye on your skin regularly, such as after showering or changing your clothes, can help you spot the condition early and seek a diagnosis from a dermatologist.

Here are some of the most common signs of vitiligo that you can check for:

• Patchy or widespread loss of skin color that usually starts appearing on areas that receive sun exposure, such as the hands, arms, feet, face, or folds of the skin (elbows, knees, or groin)
• Premature whitening of the hair on your head, eyelashes, eyebrows, or face
• Loss of color on the inside of your mouth or nose (mucous membranes)
• Changes in or loss of pigmentation in your eye color
• Pain, itching, or discomfort on the areas of the skin where the white or light patches appear

You may also want to make note of where the white or light patches appear. Doctors categorize vitiligo by the general location of the pigmentation loss.

Broadly, these categories include:

• Non-segmental vitiligo: This is the most common type of vitiligo. The white patches are often symmetrical, meaning that they appear on both sides of the body.
• Segmental vitiligo: This less-common type of vitiligo only affects one segment (area) of the skin, and it tends to stop growing once the initial patch has appeared.

If you do an initial self-check for skin depigmentation and notice changes, the next step is to schedule an appointment with your primary care doctor. This doctor will be able to refer you to a dermatologist for a more thorough evaluation.

Physical Examination

A physical examination to diagnose vitiligo starts in your doctor's office. First, they will ask you about your symptoms and take your medical history. Next, they will do a physical exam of your skin.

Medical and Family History

Here are some of the things that your doctor will likely ask you about:

• Symptom history: You will be asked when it was that you first noticed the potential vitiligo patches on your skin, if the patches have grown, and if they have spread to different areas. Depending on your age, you might also be asked if your hair turned gray before age 35.
• Family history of vitiligo: Vitiligo has a genetic component for some people. Experts estimate that roughly 20% of people with vitiligo have a close family member with the condition.
• Family history of autoimmune disease: Vitiligo is linked to autoimmune conditions. Your doctor may ask if members of your family have been diagnosed with an autoimmune disease, such as rheumatoid arthritis (RA), lupus, or thyroid disease.
• Previous skin issues: Such as having a severe sunburn, rash, or other trauma (like rubbing, friction, or intense scratching) in the areas where the white or light patches have appeared.
• Stress levels: Physically, mentally, and emotionally stressful situations—whether current or in the recent past—can contribute to vitiligo development.

Physical Exam

After the medical and symptom history portion of the appointment, your doctor will look at your skin. It will be a more thorough examination than the skin checks you may have done at home.

Your doctor will observe all areas of your skin closely and note where the depigmentation patches occur, whether they're symmetrical or random, and whether they're on primarily sun-exposed areas.

Some clinicians use a special light known as a Wood's lamp to check if the white or light patches are vitiligo. A Wood's lamp uses ultraviolet light in a dark room to illuminate areas of the skin. Vitiligo patches turn fluorescent under the lamp's light.

Labs and Tests

If doctors need more information before making a diagnosis, they may want to do a skin biopsy or blood tests to check for any underlying autoimmune disease or other skin conditions.

Skin Biopsy

A skin biopsy involves removing a small portion of the affected skin tissue to check whether there are pigment cells (melanocytes) in the skin. The skin sample will be evaluated under a microscope in the lab. If it shows that there are no pigment cells present, a diagnosis of vitiligo will likely be confirmed.

Very rarely, a form of skin cancer called hypopigmented cutaneous T-cell lymphoma may cause white patches that look similar to vitiligo patches. The discoloration happens because of malfunctioning pigment cells. A skin biopsy can rule out this possibility.

Blood Tests

Roughly 15%–25% of vitiligo patients have at least one other autoimmune disease. Your doctor may order blood tests to evaluate your overall health and specific areas of concern, such as your thyroid function.

The specific blood tests may include a complete blood count (CBC) and an antinuclear antibody test (ANA test).

Eyesight or Hearing Exams

Vitiligo has the potential to affect eyesight and hearing, though this is not common.

If you are having symptoms related to your vision or hearing, your dermatologist may refer you to an ophthalmologist (a doctor who specializes in eyesight) to check for inflammation in your eyes (uveitis) or an audiologist (a doctor who specializes in hearing) to test your hearing.

Differential Diagnosis

Whenever there is more than one possible condition that could be causing your skin symptoms, your dermatologist will use the process of differential diagnosis to confirm the cause.

Clinicians use the information from your symptom descriptions, medical history, physical exam, test results, and their own expertise in skin disorders to narrow down the list through the process of elimination.

Vitiligo is not the only cause of skin depigmentation. If your symptoms or test results don't match a typical vitiligo case, your dermatologist may look to other conditions.

Other skin pigment disorders include:

• Tinea versicolor: This common fungal infection (pityriasis versicolor) is caused by an overgrowth of yeast that occurs naturally on the skin. A primary sign of tinea versicolor is distinct patches of discolored skin and sometimes mild itching.
• Albinism: The main symptom of albinism is a lack of color in the hair, skin, or eyes. This genetic disorder happens because the body is unable to produce melanin (the pigment that gives your skin color). Albinism can affect the entire body, smaller patches of skin, and the hair and eyes.
• Hypopigmentation: This condition is when the skin is lighter in color because there is a decreased amount of melanin. It can be prompted by past skin injuries, chemical exposure, infection, and sometimes inflammatory skin conditions like psoriasis or eczema (atopic dermatitis).
• Pityriasis alba: This common, benign skin disorder typically affects children up to age 12. It's characterized by raised, round patches of lighter skin, usually seen on the face, though it can happen on other areas of the body. 
• Chemical leukoderma: Exposure to certain heavy-duty chemicals can damage the skin and cause white or lightened patches.

A Word From Verywell

Getting a diagnosis of vitiligo is just the beginning of living with the condition. Some people with vitiligo have additional symptoms to changes in skin pigmentation and may also have other autoimmune diseases.

Vitiligo can affect a person's quality of life in a negative way because of the potential psychological effects of the skin changes and social stigma.

The American Academy of Dermatology recommends finding a board-certified dermatologist in your area. Board-certified dermatologists are trained to help you manage your condition and to make supportive referrals, such as for mental health care, if necessary.