Vitiligo on Darker Skin

Vitiligo is a condition that causes patches of the skin to lose their natural color. White or lightened patches form when melanocytes (pigment cells that give color to our skin, hair, and eyes) are mistakenly destroyed by the body's immune system.

While vitiligo affects people of all skin types, it tends to be more noticeable in people with darker skin tones, contributing to additional stigmatization and psychological stress in members of Black, Brown, and Indigenous communities.

This article provides an overview of vitiligo in darker skin tones and how to help patients with darker skin actively manage the condition.

Facts and Misconceptions

Misconceptions continue to fuel stigma around vitiligo, particularly for Black and Brown patients.

Vitiligo is not contagious or life-threatening, but it often has a significant impact on quality of life, prompting heightened stress, anxiety, and stigmatization in already-marginalized patients.

How It Affects Different Skin Types

Vitiligo can affect anyone, regardless of race, ethnicity, age, or gender.

Vitiligo's most noticeable symptom—loss of skin coloration—tends to be more apparent in people with darker skin tones due to the contrast between the white patches and the person's natural skin tone.

Melanocytes and Melanin

A person's skin color stems from a process that involves cells called melanocytes. Melanocytes produce melanin, a pigment that gives your skin, hair, and eyes their unique color.

In skin pigmentation disorders like vitiligo, these melanocytes become damaged and unable to produce enough melanin, resulting in white or lightened patches.

Although the color of your skin is determined by the balance of its melanin, all people have roughly the same number of melanocytes.

Geographical Prevalence

Experts estimate that vitiligo affects up to 1% of the world's population, though many cases may go unreported. In the United States, this percentage may vary slightly depending on the region, but more research is needed to better understand how geographical location may impact vitiligo development.

A 2022 study indicated that Latinx and Hispanic patients are more likely to be living with an undiagnosed case of vitiligo, which affects overall prevalence estimates.

Link to Other Skin Conditions

Despite misconceptions, vitiligo is not related to other skin conditions like skin cancer, albinism (group of inherited conditions leading to extremely light skin, hair, and eyes), or leprosy, also called Hansen's disease (a long-term bacterial infection that causes skin lesions and nerve damage).

While in theory it's possible to have more than one of these skin conditions at the same time, vitiligo isn't the underlying cause.

Symptoms

The appearance of skin conditions in darker skin tones has been severely lacking in medical education and public health materials. Instead, a vast majority of images and descriptions focus almost solely on what skin conditions look like on White skin.

Without adequate training for healthcare providers to recognize what vitiligo looks like in different skin tones, Black and Brown patients often face a delayed or incorrect diagnosis and ineffective treatment.

Appearance

A primary symptom of vitiligo in all skin tones is white or lightened patches on the skin or in hair. These patches may look more prominent on people with darker skin tones due to the contrast between the depigmented patches and the person's natural skin color.

Vitiligo typically appears in areas where sun exposure is frequent, such as the hands, feet, face, and arms, though it can appear anywhere on the body, including:

• Mouth and eyes
• Fingers and wrists
• Armpits
• Groin
• Genitals
• Inside your mouth
  

It's also important to point out that several other pigment disorders also affect skin appearance and might be confused with vitiligo, particularly in Black and Brown patients. These include:

• Pityriasis alba: A white facial patch commonly seen in children
• Tinea versicolor: A fungal skin infection that develops into patches of discolored skin
• Albinism: A group of inherited skin disorders that result in little or no pigment in a person's skin, eyes, and hair
• Cutaneous T-cell lymphoma: A form of skin cancer, which can cause white patches that look like vitiligo (though this is rare)
  

Location

Vitiligo patches are commonly found on both sides of the body symmetrically, usually in places where there has been frequent sun exposure, friction, or trauma.

Experts have broken down the subgroups of vitiligo by location and pattern, as follows:

• Generalized vitiligo, which is the most common, means patches can appear anywhere on the body and don't have a specific size.
• Focal vitiligo involves one or just a few white patches on a small area.
• Acrofacial vitiligo describes patches found mostly on the fingers, toes, and face.
• Mucosal vitiligo involves patches that are found around the mucous membranes, like the mouth, nose, or genitals.
• Universal vitiligo is rare but happens when widespread patches cover almost the entire body.

There’s also the rarer segmental vitiligo, in which white patches appear on only one segment of the skin, like one side of the body. This type of vitiligo tends to stop growing once the initial patch is established.

When to See a Healthcare Provider

Vitiligo is not an urgent medical emergency, but it's still a medical condition. It's not just a cosmetic issue.

If possible and accessible, it's wise to see a healthcare provider as soon as you notice skin changes because people with vitiligo have a greater chance of developing certain autoimmune conditions and getting severe sunburns.

Plus, if you choose to get vitiligo treatments, the chances for a better outcome are greater with an earlier diagnosis.

Physical Examination

During an appointment for vitiligo, a healthcare provider will likely ask about your medical history and symptoms before looking at your skin. This physical examination will be more thorough than the casual skin checks you may have done at home.

For example, you can expect your healthcare provider to:

• Observe all areas of your skin closely to note where the depigmentation patches occur, whether they're symmetrical or random, and whether they're on primarily sun-exposed areas.
• Potentially shine an ultraviolet (UV) light known as a Wood's lamp against the white or lightened areas of your skin since vitiligo patches turn fluorescent under the lamp's light

If more information is needed, a healthcare provider may order the following tests:

• A skin biopsy, which involves removing a small portion of the affected skin tissue to check for melanocytes. If none is present, this likely indicates vitiligo
•  Blood tests, such as a complete blood count (CBC) or antinuclear antibody test (ANA test), to evaluate your overall health and check for any underlying autoimmune disease
  

Questions to Ask

Research shows that vitiligo patients—particularly those from Black and Brown communities—face barriers when seeking care and treatment. This includes receiving an accurate, timely diagnosis and access to recommended vitiligo treatments.

Open communication with a healthcare provider can lead to better health outcomes for you. For some patients, this communication may be more comfortable and effective when the healthcare provider shares the same racial or ethnic background. But if that's not possible, it's completely acceptable to ask a healthcare provider if they're experienced diagnosing and treating skin of color.

From there, feel encouraged to be upfront with any questions or requests you may have. Some suggestions include:

• What tests are required for a vitiligo diagnosis?
• What are my chances of developing an autoimmune condition or experiencing mental health issues related to vitiligo?
• If my treatment plan isn't effective or affordable, will you be able to provide alternative options?
• How often should I schedule follow-up visits, and will I be able to contact you between appointments if necessary?
  

Possible Co-Occurring Conditions

In addition to skin pigmentation loss, vitiligo can cause other symptoms such as pain and itching. People with vitiligo are also more likely to face conditions such as:

• Vision and hearing changes: Melanocytes in the eye and inner ear can be affected by vitiligo, leading to visions changes, abnormal tear production, and hearing loss.
• Psychological complications: Vitiligo can greatly affect a person's quality of life and may lead to symptoms of anxiety, depression, and other mental health conditions. Studies show that the quality of life in Black and Latinx/Hispanic vitiligo patients may be significantly more affected.
• Autoimmune and thyroid disease: People with vitiligo have a higher chance of also having conditions like inflammatory bowel disease (IBD), psoriasis, rheumatoid arthritis, lupus, and type 1 diabetes. Recent research suggests there may be a higher prevalence of autoimmune disease and hypothyroidism (underactive thyroid) in Black patients with vitiligo.
  

Treatment Options

There's no cure for vitiligo, but there are many different treatment options that can help slow the progression of vitiligo or return some color to white patches. However, some people choose not to treat their vitiligo at all.

Common vitiligo treatment options include:

• Topical corticosteroid creams to try to restore pigment
• UV light therapy to help stop the spread of white patches
  
• Camouflaging creams matched closely to the unaffected areas for a temporary cosmetic fix
• Depigmentation creams to remove the remaining pigment in the skin
• Surgery to graft pigmented skin onto white patches
• Janus kinase (JAK) inhibitors such as Opzelura (ruxolitinib) cream to help restore pigment
  

Keep in mind that treatment plans for patients with darker skin may require different approaches or dosages than those used for patients with light skin. For example, using UV light therapy in patients with darker skin tones may require higher doses to get results.

Summary

Vitiligo is a skin condition that causes your skin to lose melanin (pigment) in some areas, resulting in white or lightened patches. Although vitiligo is usually more noticeable on darker skin tones, research shows that it affects people of all ethnicities similarly.

Barriers to equitable health care plus a lack of medical education around what vitiligo looks like in darker skin tones make getting an accurate diagnosis and accessing effective treatments much more challenging.

A Word From Verywell

Living with a skin condition like vitiligo can be stressful and upsetting at times. It can be even more challenging when you feel marginalized for having darker skin. Through organizations like the Skin of Color Society, resources are available to help you find healthcare providers that are comfortable treating skin of color. Getting an accurate diagnosis and adequate treatment can help you live well with vitiligo.