Pronounced: vit-ill-EYE-goEn Español (Spanish Version)
Vitiligo is a disorder in which white patches develop on the skin and in the hair, eyes, and mouth. Any part of the body can be affected.
The white patches of vitiligo are due to the destruction of melanocytes, which are the cells in the skin that produce pigment. Loss of pigment causes the skin to become lighter, especially in contrast to the normally pigmented skin nearby. This is why vitiligo is particularly problematic in darker-skinned people.
The exact cause of the pigment loss is not known. Possible causes include:
- The body’s immune system may destroy the melanocytes.
- Melanocytes may destroy themselves.
- Defective nerve cells may make toxic substances that harm the melanocytes.
It is likely that a genetic defect predisposes melanocytes to damage from these and other causes.
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for vitiligo include:
- Family members with vitiligo or hair turning gray early
- Age: 10 to 30
- Certain autoimmune diseases, most notably thyroid disease
The main symptom of vitiligo is white patches on the skin, which may be clumped together or, more commonly, are widely distributed throughout the body. Some common sites of pigment loss include:
- Areas exposed to the sun: face, hands, arms, upper part of the chest
- Areas around body openings: eyes, nostrils, mouth, navel, genitals
- Body folds: groin, armpits
- Sites of chronic minor injury: knuckles, elbows
- Sites of injury: scrapes, cuts, burns
- Area right around moles
White or prematurely graying hair and hair loss may also occur.
Vitiligo often begins with a rapid loss of skin color followed by a long period without any change. Cycles of pigment loss and stability may occur again later and continue throughout life. About half of the people with vitiligo have their first pigment loss before age 20. It is rare for skin color to return without treatment.
The doctor will ask about your symptoms and medical history, and perform a physical exam, including an eye exam. The diagnosis is usually made by the appearance of the skin, but sometimes a skin biopsy is necessary. A special ultraviolet lamps may be used during skin exam to aid in the diagnosis. Blood tests are often taken to look for signs of autoimmune diseases.
There is no known cure for vitiligo. Typically, the more long-standing the depigmentation, the harder it is to repigment the area. However, there are several ways to treat existing white patches to improve your appearance. These include:
PUVA (Psoralen plus UVA)
This used to be the most common type of repigmentation until recently; now it is being largely replaced by narrow band UVB (nbUVB). You apply a psoralen cream or take a psoralen medication orally. You then expose yourself to ultraviolet light A (UV-A) from the sun or an artificial source. When this medicine is activated by UV-A, it may repigment white patches. This treatment takes months and can cause sunburn-type reactions and other adverse effects, such as nausea and increased risk of skin cancer .
This is a special ultraviolet laser shown to be effective in localized cases of vitiligo
Repigmentation involves trying to restore the normal color to areas of your skin affected by vitiligo. It is not always successful, but it may bring back some color. Methods of repigmentation include:
- Corticosteroid skin creams—Skin creams that contain corticosteroid compounds can sometimes slow the loss of color and help return color to small areas. However, they can cause thinning of the skin.
- Tacrolimus or pimecrolimus skin creams—Skin creams that contain non-corticosteroid immunomodulating compounds can sometimes slow the loss of color and help return color to small areas. However, they can cause thinning of the skin.
- Skin grafting—If the condition is not widespread and stable, it may be possible to surgically graft areas of normal pigmentation to the depigmented patches.
© 2008 Nucleus Medical Art, Inc.
Depigmentation involves removing the remaining pigment from your normal skin. This treatment makes your whole body the same white color. It is only done if you have already lost a large percentage of your normal skin color and repigmentation has not been successful or is not desirable. The medicine used is called monobenzyl ether of hydroquinone 20%. This treatment takes about one year to complete. It can cause side effects, such as redness and swelling of your skin.
You can make your white patches less noticeable with makeup, dyes, stains, or self-tanning lotions. However, the color from dyes, stains, and self-tanning lotions slowly wears off.
The purpose of sunscreen is to both protect the depigmented area from the damaging effects of sun exposure and to prevent increased pigmentation (tanning) of other areas, which will greatly accentuate the vitiligo. It is critical to remember that depigmented areas are at much higher risk for skin cancer.
There is no known way to prevent vitiligo. However, it is important to protect the depigmented areas from excessive sun exposure by wearing protective clothing and applying sunscreen. Some other medical conditions occur more commonly in persons with vitiligo than in those without this disorder. If you have vitiligo, your doctor will likely ask periodically about symptoms that might indicate the development of another vitiligo-related disorder.
National Vitiligo Foundation
American Academy of Dermatology
Canadian Dermatology Association
American Academy of Dermatology website. Available at: http://www.aad.org .
Kanwar AJ, Dogra S, Parsad D, Kumar B. Narrow-band UVB for the treatment of vitiligo: an emerging effective and well-tolerated therapy. Int J Dermatol. 2005;44:57-60.
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .
National Vitiligo Foundation website. Available at: http://www.vitiligofoundation.org/ .
Last reviewed November 2007 by Ross Zeltser, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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