What is Vitiligo? Symptoms, Causes, Diagnosis, Treatment, and Prevention
This skin disorder can occur in people of any race. Itâ€™s most noticeable, though, among people with darker skin, because the contrast between normal skin tone and the white patches affected by vitiligo is more pronounced, notes the National Institute of Arthritis and Musculoskeletal and Skin Diseases. (4)
People with vitiligo experience skin color loss in various areas of the body. Often itâ€™s symmetrical, affecting both sides, such as the left and right hands or both knees. Some experience discoloration in the mouth, on the scalp, or of their hair, eyelashes, or eyebrows. (1)
Signs and Symptoms of Vitiligo
The biggest sign that someone may have vitiligo is the appearance of light or â€œdepigmentedâ€ spots on the skin, says Suzanne Friedler, MD, a dermatologist in private practice in New York City. The pale patches are areas with little or no melanin, the skinâ€™s natural pigment. These spots can show up anywhere on the body, though they may first appear in areas that receive a lot of sun exposure, such as on the face, arms, feet, and hands. (3,4,5) Itâ€™s also not uncommon for white areas to appear in the groin, armpits, and around the belly button. (3,5)
Where skin spots appear, how widespread the condition becomes, and how much it will progress vary from person to person.
There are two major types of vitiligo:
You may also have mixed vitiligo, a combination of nonsegmental and segmental vitiligo. (3)
Importantly, vitiligo can cause significant psychological distress. Many people with vitiligo struggle with self-esteem, confidence, and social anxiety, especially if the vitiligo affects areas of the skin that are tough to hide under clothes or minimize with cosmetics, notes the NHS. (9)
â€œVitiligo can have a significant effect on patients,â€ says Adrienne Haughton, MD, clinical assistant professor of dermatology and director of medical and cosmetic dermatology at Stony Brook Medicine in Commack, New York. â€œPatients can be very self-conscious and even experience depression.â€
Causes and Risk Factors for Vitiligo
â€œIt happens when a part of the immune system starts to attack and kill the pigment cells â€” melanocytes â€” in the skin, resulting in the formation of white patches,â€ says Michelle Rodrigues, MBBS, a dermatologist in private practice in Melbourne, Australia. Melanocytes are cells that produce melanin, the pigment that gives skin, hair, and eyes their color, per the National Library of Medicine. (10)
So why might the bodyâ€™s immune cells attack healthy skin cells in the first place? That question is still not entirely settled among researchers, according to the American Academy of Dermatology. (1) But it seems likely that genetics and environmental triggers both play a role.
These factors are known to increase risk for vitiligo:
- Family History and Genes About 30 percent of people with vitiligo have a family history of this skin disorder, notes Harvard Medical School. (11) Researchers have found that having a certain genetic profile makes people more susceptible to developing vitiligo. (2) Nearly 50 genes have been identified that are associated with vitiligo, including two called NLRP1 and PTPN22. (5) These and other genes now linked with vitiligo are known to be involved with immune- system regulation and inflammation.
- Environmental Triggers Vitiligo seems to be the result of both a preexisting genetic makeup and something in the environment setting off an autoimmune response that destroys melanocytes. Potential triggers include sunburn, exposure to certain chemicals, and trauma or injury to the skin. (7) These triggers can also prompt vitiligo to spread in people who already have the condition.
- An Existing Autoimmune Disease People with an autoimmune disease, such as psoriasis, systemic lupus erythematosus, Hashimotoâ€™s disease, or alopecia areata, are at an increased risk of developing vitiligo. (1) Several genes associated with vitiligo are also linked to other autoimmune conditions, such as rheumatoid arthritis, type 1 diabetes, and thyroid disease. (4) Roughly 1 in 4 people with vitiligo have another autoimmune disease. (5)
How Is Vitiligo Diagnosed?
If you suspect you may have vitiligo, visit your primary care doctor or a dermatologist. At your appointment, your doctor will likely ask about risk factors such as:
- Whether a close relative has been diagnosed with vitiligo
- Whether you have been diagnosed with an autoimmune disorder
- If youâ€™ve experienced recent stress (such as a major life change) or other potentially triggering events (such as a severe sunburn), per the Mayo Clinic (12)
Most of the time, doctors diagnose vitiligo by visually examining white patches on the skin and considering your medical history, according to NYU Langone. (13) Your physician may use a Woodâ€™s lamp, which uses ultraviolet light to identify pigment loss. This lamp is especially useful for people with fairer skin where the difference in color is subtler.
Some dermatologists will want to do more testing beyond a skin exam. Your doctor may order a skin biopsy, which will show whether melanocytes are present in the skin. A lack of melanocytes is an indication of vitiligo. He or she may also ask for a blood test to see if you have another autoimmune disease. (13)
Your doctor may also perform an eye exam for uveitis, a form of eye inflammation that can be associated with vitiligo. Your doctor will also rule out other skin conditions that can look similar to vitiligo, such as skin damage from exposure to industrial chemicals called chemical leukoderma; tinea versicolor, a yeast infection that can lighten or darken areas of skin; and albinism, a genetic condition marked by low levels of melanin in skin, hair, and eyes, notes the Cleveland Clinic. (14)
Prognosis for Vitiligo
What is your prognosis if youâ€™re diagnosed with vitiligo? While this skin condition cannot be cured, treatments can slow or stop its spread, spur some regrowth of melanocytes, and improve the appearance of patchy skin by returning some color to white areas. (5) Cosmetics can reduce the appearance of vitiligo patches, too. And cognitive behavioral therapy can help you overcome the depression and social anxiety that this skin condition so often causes. (3)
Duration of Vitiligo
Once vitiligo develops, it is usually a life-long condition. You may have a 10 to 20 percent chance that your skinâ€™s natural color will be restored, especially if you are young, if your vitiligo developed in less than six months, and if it the white patches are mostly on your face, according to the Cleveland Clinic. (15)
Treatment and Medication Options for Vitiligo
There is not currently a cure for vitiligo, says Michele Green, MD, a dermatologist in private practice in New York City.
But a growing variety of treatment options can minimize the appearance of white skin spots.
Nondrug and nonsurgical therapies include: (12,16)
- Makeup and self-tanners, which can cover up white patches and hair dye to bring color back to graying or white hair
- Light therapy, specifically narrowband UVB, according to Dr. Haughton
Medication and Surgery Options for Vitiligo
Sometimes medication can help minimize the appearance of vitiligo. Treatments include: (12, 16)
- Corticosteroid creams
- Ointments containing tacrolimus or pimecrolimus,
- Topical vitamin D analogs (which are synthetic versions of the vitamin)
- Topical immunomodulators (medication that regulates the skinâ€™s immune response), such as calcineurin inhibitors
- Combination therapy with UVA light and the oral medication psoralen, which may be especially effective if you have large areas of skin affected by vitiligo
- Pigment removal from unaffected skin using monobenzone cream
- Surgery, including skin grafting, blister grafting, and tattooing
Some of these treatment options come with negative side effects, such as scarring, dry and itchy skin, and skin with a streaky appearance.
Alternative and Complementary Therapies for Vitiligo
There have also been a few research studies on alternative medicine options, such as treating the area with certain herbs and vitamins. (12) But so far the studies have been too small to draw sweeping conclusions, says Hal Weitzbuch, MD, a dermatologist in private practice in Calabasas, California, and an adjunct professor of dermatology at the University of Southern California. Donâ€™t rely on unproven natural remedies instead of getting the medical care you need for vitiligo, he says.
Itâ€™s also important to note that many individuals do not require or want treatment to minimize or conceal their vitiligo patches, since the visible patches pose no physical risks to people with them, says the Vitiligo Society. (17) Your doctor or dermatologist can help you decide which treatment option, if any, is best for you.
Complications of and Conditions Related to Vitiligo
In general, people who have been diagnosed with vitiligo do not need to be overly worried about developing serious complications.
Vitiligo and Skin Cancer Risk
People with vitiligo â€” like the rest of the population â€” are encouraged to wear sunscreen (specifically a broad-spectrum, water-resistant option with an SPF of 30 or higher). (12) Part of that is because skin without its natural color is more likely to burn in the sun. A function of melanin (the pigment that gives skin color, which is missing in patches of skin in people with vitiligo) is to help block out some of the sunâ€™s dangerous ultraviolet rays, so skin without it may be more vulnerable to sun damage, according to the American Cancer Society. (18) But sun protection is also important because avoiding getting tan can make vitiligo patches less noticeable, and some vitiligo treatments can be disrupted by sun exposure. (1)
There are a few theories for why this might happen. The same genes associated with vitiligo may also lower the risk of malignant melanoma; a second theory says that whateverâ€™s causing the immune system to destroy melanocytes also causes it to destroy cancerous cells. (20,21)
Vitiligo and Other Autoimmune Disorders
About one-quarter of patients with vitiligo have another autoimmune disease. If you have vitiligo, you may be at risk for an autoimmune disorder. So itâ€™s important to discuss any new or unusual health issues youâ€™re experiencing with your primary care practitioner. (5) Vitiligo does not cause other autoimmune conditions; but it may share a genetic basis with one.
Here are some of the most common autoimmune diseases associated with vitiligo:
- Autoimmune thyroid disease
- Rheumatoid arthritis
- Type 1 diabetes
- Pernicious anemia
- Addison's disease
- Systemic lupus erythematosus
Vitiligo and Mental Health Complications
The other concern when it comes to vitiligo complications is the emotional toll of living with a very visible skin condition, especially one that can begin early in life.
â€œItâ€™s a stigma â€” people have this aversion because itâ€™s not â€˜normal,â€™â€ says Sandy Skotnicki, MD, a dermatologist and assistant professor in the department of medicine at the University of Toronto in Ontario, Canada. It can be especially difficult for people with darker skin, Dr. Skotnicki says, because the differences in skin tone are more obvious. For people with light skin, the presence of vitiligo may be less noticeable, Skotnicki says.
Research and Statistics: How Many People Have Vitiligo
The disorder often begins early in life, with 25 percent of cases occurring in children younger than 10 years old, one-half happening in kids and teens younger than age 20 and up to 80 percent striking before age 30. (3) It has developed infants and in adults as old as those in their mid-fifties. (3)
Promising research is underway examining the genetic roots of vitiligo and testing compounds and treatments that may interrupt the autoimmune response, inflammation and the destruction of melanocytes. Areas of current vitiligo research include: (19)
- Medication that promotes the growth of melanocytes
- Medication intended to bring color back to the affected area
- Medication that works in conjunction with light therapy
- A skin grafting surgery called noncultured epidermal cell suspension (4)
- Immune-targeting therapy to reverse the condition (4)
- Gene therapy that reprograms melanocytes to prevent an autoimmune reaction (23)
- Topical medication, such as experimental cerdulatinib gel, to inhibit inflammation, per CinicalTrials.gov (24)
In addition to the investigation of these novel treatments, much of the latest vitiligo research has focused on gaining a better understanding of the genes involved with how the condition starts in the first place. By doing so, researchers hope to get closer to developing a treatment that prevents vitiligo from occurring or spreading. (4)
And, since something in the environment is responsible for triggering vitiligo (as people are not born with the condition), researchers have also focused on understanding what those triggers are and why they incite such a response within the cells. (7)
Why People With Vitiligo Are Joining the Body Positive Movement
Soto was diagnosed with vitiligo at the age of 12 after she saw a white spot on her neck and then noticed another one appear within a few months. â€œI remember being really scared and confused,â€ she says.
As for Soto, sheâ€™s all for vitiligo being included in the body positive movement. â€œWhen I was younger, I didnâ€™t have anybody to look up to,â€ she says. â€œItâ€™s so important for us to raise awareness for kids who are being diagnosed now.â€
Since vitiligo doesnâ€™t usually go away over time, itâ€™s important that vitiligo patients develop coping strategies by learning about the condition and connecting with others who are living with it, too. (1)