Causes and The Affected

Vitiligo is a disease that causes the loss of skin color in blotches. The extent and rate of color loss from vitiligo is unpredictable. It can affect the skin on any part of your body. It may also affect hair, the inside of the mouth and even the eyes.

Normally, the color of hair, skin and eyes is determined by melanin. Vitiligo occurs when the cells that produce melanin die or stop functioning.

Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin. The condition is not life-threatening or contagious. Treatment for vitiligo may improve the appearance of the affected skin but does not cure the disease.

Vitiligo Symptoms

Skin discoloration

Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard (usually before age 35)

Loss of color in the tissues that line the inside of your mouth and nose (mucous membranes)

Loss of or change in color of the inner layer of the eyeball (retina)

Discolored patches around the armpits, navel, genitals and rectum

Vitiligo can start at any age, but most often appears before age 20.

Depending on the type of vitiligo you have, the discolored patches may cover:

Many parts of your body. With this most common type, called generalized vitiligo, the discolored patches often progress similarly on corresponding body parts (symmetrically).

Only one side or part of your body. This type, called segmental vitiligo, tends to occur at a younger age, progress for a year or two, then stop.

One or only a few areas of your body. This type is called localized (focal) vitiligo.

When to see a doctor

See your doctor if areas of your skin, hair or eyes lose coloring. Vitiligo has no cure. But treatment may help to stop or slow the discoloring process and return some color to your skin.

Increased Risk

Social or psychological distress

Sunburn and skin cancer

Eye problems, such as inflammation of the iris (iritis)

Hearing loss

Side effects due to treatment, such as dry skin and itching

Diagnosis

Medical history and exam

If your doctor suspects you have vitiligo, they will ask about your medical history, examine you and try to rule out other medical problems, such as dermatitis or psoriasis. They may use a special lamp to shine ultraviolet light onto the skin to determine whether you have vitiligo.

Skin biopsy and blood draw

In addition to gathering your personal and family medical history and examining your skin, your doctor may take a small sample (biopsy) of the affected skin or draw blood for lab tests.

Other exams

Your doctor may recommend that you see an eye specialist, who may check for inflammation in your eye. Your doctor may also suggest that you see a hearing specialist to undergo a hearing evaluation because people with vitiligo may have an increased risk of hearing loss.

Treatment

Medication

Creams that control inflammation. A topical corticosteroid may help return color to your skin, particularly if you start using it early in the disease. You may not see a change in your skin's color for several months. This type of cream is effective and easy to use. But it can cause side effects, such as skin thinning or the appearance of streaks or lines on your skin.

A form of vitamin D. Topical calcipotriene (Dovonex) is a cream that can be used with corticosteroids or ultraviolet light. Possible side effects include dry skin, rash and itching.

Medications that affect the immune system. Ointments containing tacrolimus or pimecrolimus (calcineurin inhibitors) may be effective for people with small areas of depigmentation, especially on the face and neck. This treatment may have fewer side effects than corticosteroids and can be used with ultraviolet B (UVB) light.

Therapy

Light therapy. This treatment uses narrow band UVB light. You may receive treatment in a doctor's office up to three times a week. The best results are achieved on the face, midsection and limbs.

Laser therapy. This procedure brings color back to patches of light skin by treating them with an excimer laser, which uses a specific wavelength of UVB light. It can be used only on small areas, and it's often used in combination with a drug applied to the skin. Side effects can include redness and blistering.

Removing the remaining color (depigmentation). This therapy may be an option if your vitiligo is widespread and other treatments haven't worked. A medication with monobenzone is applied to unaffected areas of skin. This gradually lightens it so that it blends with the discolored areas. The therapy is done twice a day for nine months or longer. You'll need to avoid skin-to-skin contact with other people for at least two hours after you've applied the drug, so you don't transfer it to them. Side effects can include redness, swelling, itching and dry skin. Depigmentation is permanent, and you'll always be extremely sensitive to sunlight.

Surgery

Skin grafting. In this procedure, your doctor removes very small sections of your normal, pigmented skin and attaches them to areas that have lost pigment. This procedure is sometimes used if you have small patches of vitiligo. Possible risks include infection, scarring, a cobblestone appearance, spotty color and failure of the area to recolor.

Blister grafting. In this procedure, your doctor creates blisters on your pigmented skin, usually with suction. They then remove the tops of the blisters and transplants them to an area of discolored skin. Possible risks include scarring, a cobblestone appearance and failure of the area to recolor. The risk of scarring is less with this procedure than with other types of skin grafting.

Tattooing (micropigmentation). In this technique, your doctor uses a special surgical instrument to implant pigment into your skin. It's most effective around the lips, especially in people with darker skin. Drawbacks include difficulty matching the skin color, the tendency of tattoos to fade and their inability to tan. Also, the skin damage caused by tattooing may trigger another patch of vitiligo.

Life Changes

Protect skin from the sun and artificial sources of UV light. If you have vitiligo, particularly if you have light skin, use a broad-spectrum, water-resistant sunscreen with an SPF of at least 30. Protecting skin from the sun helps prevent sunburn and long-term damage. A bad sunburn can make the condition worse. Sunscreen also minimizes tanning, which makes the contrast between normal and discolored skin less noticeable.

Conceal affected skin. Concealing products may improve the appearance of the skin and help you feel better about yourself, especially if your vitiligo patches are on exposed skin.

Don't get a tattoo. Avoid tattooing that's not related to treating your vitiligo. Damage to your skin, such as that caused by a tattoo, may cause a new patch of vitiligo to appear within two weeks.