Vitiligo (a disorder that causes pigment loss in the skin and other parts of the body) doesnâ€™t pose a major threat to your health, and itâ€™s not usually painful or itchy, but receiving a diagnosis could bring you peace of mind and help you understand whatâ€™s happening to your skin. (2)
"Scheduling an appointment with your dermatologist is the best way to diagnose vitiligo," Hal Weitzbuch, MD, a dermatologist in private practice in Calabasas, California.
At your appointment, your doctor may ask about: (1,2)
- The history of the patches Expect questions such as: When did they first appear? Have they been spreading or staying in one area?
- Your health history The doctor will likely be interested in hearing if you have been diagnosed with an autoimmune disease.
- Family history of vitiligo Vitiligo tends to run in families. In fact, about 20 percent of people with vitiligo also have one or more close relatives with the same issue.
- Any recent stressful events A doctor may ask about recent events that have stressed you out physically or emotionally, such as life changes or severe sunburns.
Here are some questions that might be helpful for you to ask your doctor at your appointment: (1)
- Whatâ€™s causing these symptoms?
- Will this condition last forever?
- What are my treatment options?
- What are the potential side effects of these treatments?
- Are there any lifestyle changes you recommend I make?
Usually Doctors Can Diagnose Vitiligo by Looking at Your Skin and Asking About Your Health History
Most of the time, a dermatologist will be able to diagnose vitiligo after examining your skin. (2) He or she will look for symptoms associated with other skin conditions, such as psoriasis, in order to rule them out. (1) Your doctor will probably look at every area of your skin in order to determine which type of vitiligo you have based on where the patches appear.
Itâ€™s usually easy to see the patches on dark skin. But for lighter-skinned people where thereâ€™s less distinction between the affected skin and unaffected skin, the doctor might use a tool called a Wood lamp, which shines ultraviolet light. Skin with vitiligo will look different under this type of light. (2) The tool can also be used to distinguish loss of pigment versus a reduction in color (which may be the sign of an inflammatory rash). (3)
Appearance, along with the answers to those questions about your medical history, are usually all it takes to be diagnosed, though some doctors may recommend additional tests to be sure. A skin biopsy, for instance, will show whether melanocytes are present. A lack of melanocytes can confirm a vitiligo diagnosis. (2)
The skin biopsy can also indicate whether or not youâ€™re dealing with a skin cancer called hypopigmented cutaneous T-cell lymphoma. Some doctors will recommend a blood test to see if the vitiligo is related to an underlying autoimmune disease, such as anemia or type 1 diabetes. (1) Blood test results are typically available within a week. (2)
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Thereâ€™s No Cure for Vitiligo, but Treatment Can Help Lessen Its Appearance
â€œThere is no cure [for vitiligo], and it does not go away,â€ says Michele Green, MD, a New York Cityâ€“based dermatologist in private practice. There are, however, treatment options to even out the skin tone and make the patches less noticeable.
Green says some of the most effective ways to minimize the appearance of vitiligo include applying sunscreen regularly (which can help prevent the spread of vitiligo and lessen the contrast between your natural skin tone and discolored skin) and using makeup to cover the white spots. Self-tanning products may also help. (1)
The medications available now donâ€™t stop vitiligo from spreading, but they can in some cases restore some skin color. Anti-inflammatory corticosteroid creams have been shown to help, especially if you start using one soon after your diagnosis. It may take several months to notice a difference, and it may cause side effects, such as streaky-looking skin. (1)
Ointments that contain the drugs tacrolimus or pimecrolimus can help vitiligo that affects small areas, such as the face or neck. (1) The U.S. Food and Drug Administration, however, says there could be a link between these medications and skin cancer and lymphoma. (1)
Another way to treat vitiligo is through light therapy, or exposing skin to ultraviolet light to stimulate the growth of pigment-producing cells. Itâ€™s an effective treatment, though you may need to repeat the treatments three times a week for up to a year. (1).
Your doctor may recommend combining light therapy with psoralen, which is a plant-derived medication that can help restore color to the area, though this increases the risk of developing a burn and a skin cancer in that area.
In some cases, depigmentation â€”a therapy that evens out the skin tone by removing pigment from skin thatâ€™s been unaffected â€” is an option. This treatment is usually needed one or two times per day for about nine months and tends to be the most helpful for people who have very widespread cases and havenâ€™t had success with other treatment options. The change in your skin tone will be permanent. The skin will be sensitive to light going forward, and you may also experience dryness, itching, or swelling. (1)
Some people turn to surgery if therapy doesnâ€™t work. There are three usual surgeries: (1)
- Skin grafting involves removing small sections of normally pigmented skin and attaching them to areas that have lost color.
- Blister grafting involves transplanting intentionally created blisters from areas of normally pigmented skin to areas where color is gone.
- Tattooing â€” though it may be difficult for a doctor to match the original skin tone exactly
All these options aim to bring color back to the skin. Tattooing is particularly helpful for people with dark skin who have vitiligo around or in their mouths.
There are some negative side effects to be aware of for each of these surgical options, such as scarring, skin that has a cobblestone appearance, and the potential triggering of vitiligo elsewhere on the body. (1)
Itâ€™s also important to know that sometimes these treatments don't stick, and new patches may appear even if it seems to be working well on existing ones.
Thereâ€™s Some Evidence Alternative Therapies May Help Skin Pigment Return, but Itâ€™s Very Limited
â€œVitamin deficiencies may be a trigger for the loss of pigmentation,â€ says Suzanne Friedler, MD, a dermatologist in private practice in New York City. So itâ€™s a good idea to talk to your doctor about any potential deficiencies you might have, as supplements or dietary changes may help.
Thereâ€™s also some evidence that supplementing with certain herbs and vitamins may help, such as the herb ginkgo biloba and alpha-lipoic acid, folic acid, vitamin C, and vitamin B12 when combined with phototherapy. (1)
But Dr. Weitzbuch points out that the evidence is very limited. â€œA variety of vitamins and supplements have shown some benefit in small studies, but nothing has conclusively been shown to be very effective,â€ he says.
And remember to check with your doctor before trying a supplement; some may interact with other medications youâ€™re taking or result in unintended side effects.
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