An Overview of Vitiligo

Vitiligo, also called piebald skin or acquired leukoderma, is a condition in which pigment, produced by cells called melanocytes, is lost from areas of the skin, causing whitish, smooth patches. Hair that grows in those areas may also be affected, turning white as well.

Vitiligo is neither dangerous nor contagious, but people with visible patches may feel self-conscious about their appearance.

Symptoms

The primary symptom of vitiligo is a loss of pigment that occurs in patches on any area of the body. Other symptoms can include:

• Premature whitening or graying of the hair on the head, eyelashes, eyebrows, or beard
• Itching and discomfort in the affected areas
• Loss of color in the mucous membranes (tissues that line the inside of your mouth and nose)
• Loss of or change in color of the inner layer of the eyeball (retina)

Causes

Vitiligo belongs to a group of conditions known as autoimmune diseases. These are ones in which the body's immune system attacks its own tissue or cells—in this case, the melanocytes (pigment cells that give skin its color). There is no clear-cut reason why the melanocytes die, but genetics are thought to play a role.

Researchers have found a clear genetic connection between vitiligo and other autoimmune diseases. Specifically, vitiligo is associated with:

• Autoimmune thyroid diseases like Hashimoto's thyroiditis and Graves' disease
• Pernicious anemia
• Rheumatoid arthritis
• Psoriasis
• Lupus
• Inflammatory bowel disease
• Type 1 diabetes

A number of factors are considered trigger events for vitiligo for those who are predisposed to the condition, including:

• Stressful events or chronic stress
• Severe sunburn
• Exposure to harsh chemicals
• Viruses

Types

The location and prevalence of symptoms vary, depending on which type of vitiligo you have. Types include:

Non-Segmental Vitiligo

This is the most common type of vitiligo. The patches are visible on both sides of the body and are typically symmetrical. The spots are most commonly found in areas exposed to the sun or on skin subjected to pressure, friction, or trauma.

There are five subcategories of non-segmental vitiligo:

• Generalized: Patches are of no specific size and can appear anywhere on the body.
• Acrofacial: Patches occur mostly on the fingers, toes, and face.
• Mucosal: Patches are found around mucous membranes and lips or genital mucosa.
• Universal: This is a rare manifestation in which patches cover most of the body.
• Focal: More likely in children, patches due to this type occur in a small area.

Segmental Vitiligo

This form of vitiligo, which is much less common than non-segmental vitiligo, affects only one segment of skin and tends to stop growing once the initial patch is established.

Mixed Vitiligo

In mixed vitiligo, there is a combination of both segmental and non-segmental vitiligo.

Vitiligo Minor or Hypochromic Vitiligo

This type is characterized by a few scattered white patches on the trunk and scalp, and it is often found in people with dark skin tones.

Diagnosis

If you have symptoms of vitiligo, your primary care doctor will likely refer you to a dermatologist for an accurate diagnosis. The dermatologist will evaluate your family history and medical history, and perform a physical exam. They may ask:

• If you have other family members with vitiligo
• If you have a family history of autoimmune diseases
• If you had a serious rash or sunburn prior to the white patches showing up
• If you are under physical or mental stress
• If your hair turned gray before age 35

Dermatologists may use a special light called a Wood's lamp to determine if your white patch is vitiligo. Vitiligo fluoresces (glows) when the purple Wood's lamp is shined onto the skin.

Your practitioner may perform blood tests to evaluate for any underlying autoimmune disease. In some cases, they may also perform a skin biopsy to rule out any more serious skin conditions, such as cancer.

Treatment

Vitiligo can be difficult to treat since the progression of the disease varies so much depending on the case. Sometimes the patches stop forming without treatment, but often pigment loss spreads. Rarely, the skin gets its color back.

While there are many treatment options for vitiligo, there is no cure.

Currently, treatment options include:

• Topical treatments, such as steroid creams and Opzelura (ruxolitinib), which can—in some cases—restore pigment
• Light therapies, in which UVA or UVB light is used to stop the spread of white patches
• Surgery, in which pigmented skin is grafted onto white patches
• Depigmentation creams, which, over a period of months, bleach the unaffected areas to match the white patches
• Natural and complementary therapies
• Camouflaging creams matched closely to the unaffected areas for a temporary cosmetic fix

Some people choose not to treat their vitiligo at all since there is no medical reason to do so.

A Word From Verywell

While vitiligo is not a serious disease, people differ in how they view it when it affects them. Some confidently embrace changes to their skin, while others find it takes a toll on self-esteem.

Being well informed about the condition and seeking out proper care from a dermatologist can help you manage your expectations and symptoms. Connecting with others with vitiligo can help you cope with any feelings you may have about your condition.