Vitiligo is a condition that causes the skin to lose pigmentation. Areas of discoloration may grow over time. If the condition has affected a part of the body that has hair, the hair in this area may also lose pigmentation. Vitiligo usually starts on the hands, arms, feet, and face, or the tissue that lines the inside of your mouth and nose.
Vitiligo occurs when pigment-producing cells - called melanocytes - stop producing melanin (the pigment that gives skin and hair its color). When these cells stop working or die, the skin and hair in that area begin to turn white.
Some possible causes of vitiligo include:
An autoimmune disorder mistakenly attacks melanocytes, killing them and discoloring skin.
Vitiligo is a genetic condition that runs in families. About 30% of individuals diagnosed with vitiligo have a family history of the condition.
Exposure to certain harsh chemicals or severe emotional stress may cause melanocytes to self-destruct.
There are various forms of vitiligo that affect different parts of the body.
Different types of vitiligo include:
- Generalized vitiligo: The most common form of the condition, generalized vitiligo causes small patches - or macules - of discoloration on various parts of the body. These patches usually occur in the same area on either side of the body; for instance, you may have symmetrical macules of discoloration on either hand.
- Segmental vitiligo: Discoloration appears only on one side or area of the body.
- Focal vitiligo: A small patch of discoloration occurs in a single area of the body and does not spread.
- Mucosal vitiligo: Discoloration appears in the mucous membrane (tissue lining) of the mouth and nose.
- Universal vitiligo: Rarer than the other forms, universal vitiligo occurs when 80% or more of the body’s skin has become discolored.
Vitiligo in and of itself is not painful or uncomfortable. However, skin that has lost pigmentation may be more likely to experience sunburn or light sensitivity. Individuals with vitiligo may also experience eye problems or autoimmune disorders.
Vitiligo affects about 1% of the world’s population. Discoloration usually begins to occur in childhood or young adulthood and progresses throughout life. There is no cure for vitiligo, although cosmetic therapies exist to restore or eliminate pigmentation, to create an even skin tone.
Treatment Options
There is no cure for vitiligo. Instead, therapies for the condition revolve around evening skin tone. During your appointment, talk to your health care provider about the treatment plan that’s right for you.
Corticosteroid medication - prescribed as an oral tablet or ointment - may return color to the skin when applied in the early stages of vitiligo. It may take several months for the effects of these medications to begin to appear on the skin and may result in skin thinning or streaking on the skin. Your provider may schedule recurring appointments to monitor the progress of this therapy and any side effects you may experience.
In addition, to corticosteroid medication, your provider may recommend light therapy as a treatment for vitiligo. Phototherapy is usually performed 2-3 times a week, either at a doctor’s office or home with a small, handheld device. Light therapy uses narrowband ultraviolet B (UVB) light on large patches of discoloration to slow or stop the progression of the disease.
For large areas of skin affected by vitiligo, ultraviolet light A (PUVA) phototherapy may be combined with a plant-derived substance known as psoralen to return color to the skin.
Frequent exposure to ultraviolet light may increase your risk of developing skin cancer. Before starting phototherapy, talk to your doctor about any medication you may be taking, and discuss whether or not this form of treatment is safe for you.
- Skin grafting: Skin grafting procedures take a small section of healthy, pigmented skin to cover small areas of discolored skin. Skin grafting is used for small patches of vitiligo and may result in some scarring.
- Cellular suspension transplant: This newer procedure transplants the healthy, pigmented cells from areas of the body unaffected by vitiligo to a discolored patch of skin. This may result in an uneven skin tone and some scarring, but cellular suspension is generally considered safe and effective.
If vitiligo is widespread across the body, your doctor may recommend depigmentation therapy to even skin tone. A depigmenting agent is applied once or twice a day to areas of the skin that have not been affected by vitiligo.
Gradually, this therapy will lighten skin to reduce discrepancies in tone. Depigmentation is permanent and may cause itching, inflammation, and excessively dry skin. Before starting depigmentation therapy, talk to your doctor about its effects and discuss whether or not this is the right treatment for you.