Vitiligo is a skin condition in which patches of skin loses their color. The total area of skin that can be affected by vitiligo varies between individuals. It can also affect the eyes, the inside of mouth, and the hair. In most cases, the affected areas remain discolored for the rest of the person’s life.
The condition is photosensitive. This means that the areas that are affected will be more sensitive to sunlight than those that are not.
It is hard to predict whether the patches will spread, and by how much. The spread might take weeks, or the patches might remain stable for months or years. The lighter patches tend to be more visible in people with dark or tanned skin.
The disorder can also cause hair to lose its pigment and turn white. The condition can affect people of any race, but is more noticeable in people with darker skin and hair.
General vitiligo is believed to be an autoimmune condition, which means the immune system mistakenly attacks pigment-producing cells (melanocytes).
The condition affects up to 2 percent of the world’s population, according to the Vitiligo Research Foundation.
People with darker skin are more likely to experience difficulties, because the contrast is greater. In India, vitiligo is known as “white leprosy.”
The exact causes of vitiligo are unclear. A number of factors may contribute.
- an autoimmune disorder, in which the immune system becomes overactive and destroys the melanocytes
- a genetic oxidative stress imbalance
- a stressful event
- harm to the skin due to a critical sunburn or cut
- exposure to some chemicals
- a neural cause
- heredity, as it may run in families
- a virus
Vitiligo is not contagious. One person cannot catch it from another.
It can appear at any age, but studies suggest that it is more likely to start around the age of 20 years.
The only symptom of vitiligo is the appearance of flat white spots or patches on the skin. The first white spot that becomes noticeable is often in an area that tends to be exposed to the sun.
It starts as a simple spot, a little paler than the rest of the skin, but as time passes, this spot becomes paler until it turns white.
The patches are irregular in shape. At times, the edges can become a little inflamed with a slight red tone, sometimes resulting in itchiness.
Normally, however, it does not cause any discomfort, irritation, soreness, or dryness in the skin.
The effects of vitiligo vary between people. Some people may have only a handful of white dots that develop no further, while others develop larger white patches that join together and affect larger areas of skin.
Common body areas where vitiligo will appear are:
Common areas include:
- backs of the hands
- armpit and groin
Vitiligo does not develop into other diseases, but people with the condition are more likely to experience:
- painful sunburn
- hearing loss
- changes to vision and tear production
A person with vitiligo is more likely to have another autoimmune disorder, such as thyroid problems, Addison’s disease, Hashimoto’s thyroiditis, type 1 diabetes, or pernicious anemia. Most people with vitiligo do not have these conditions, but tests can be done to rule them out.
The American Academy of Dermatology (AAD) describes vitiligo as “more than a cosmetic problem.” It is a health issue that needs medical attention.
A number of remedies can help decrease the visibility of the condition.
The AAD recommend using a sunscreen, because the lighter patches of skin are especially sensitive to sunlight and they can burn easily. A dermatologist can advise on a suitable type.
Phototherapy with UVB light
Exposure to ultraviolet B (UVB) lamps is a common treatment option. Home treatment requires a small lamp and allows for daily use, which is more effective.
If the treatment is done in a clinic, this will need 2 to 3 visits a week and the treatment time will be longer.
If there are white spots across large areas of the body, UVB phototherapy may be used. This involves full-body treatment. It is done in a hospital.
UVB phototherapy, combined with other treatments, can have a positive effect on vitiligo. However, the result is not totally predictable, and there is still no treatment that will fully re-pigment the skin.
Phototherapy with UVA light
UVA treatment is usually conducted in a health care setting. First, the patient takes a drug that increases the skin’s sensitivity to UV light. Then, in a series of treatments, the affected skin is exposed to high doses of UVA light.
Progress will be evident after 6 to 12 months of twice-weekly sessions.
In cases of mild vitiligo, the patient can camouflage some of the white patches with colored, cosmetic creams and makeup. They should select tones that best match their skin features.
If creams and makeup are correctly applied, they can last 12 to 18 hours on the face and up to 96 hours for the rest of the body. Most topical applications are waterproof.
When the affected area is widespread, covering 50 percent of the body or more, depigmentation can be an option. This reduces the skin color in unaffected parts to match the whiter areas.
Use strong topical lotions or ointments, such as monobenzone, mequinol, or hydroquinon.
The treatment is permanent, but it can make the skin more fragile. Long exposure to the sun must be avoided. Depigmentation can take 12 to 14 months, depending on factors such as the depth of the original skin tone.
Corticosteroid ointments are creams containing steroids. Some studies have concluded that applying topical corticosteroids to the white patches can stop the spread. Others have reported total restoration of the original skin color. Avoid using Corticosteroids on the face.
If there is no improvement after a month, or if side effects occur, treatment should stop.
Calcipotriene is a form of vitamin D used as a topical ointment. Side effects include rashes, dry skin, and itching.
Drugs affecting the immune system
Ointments containing tacrolimus or pimecrolimus, drugs known as calcineurin inhibitors, can help with smaller patches of depigmentation. Drug side affects may include skin cancer and lymphoma.