What is Vitiligo?
A skin disorder that causes the skin to lose its colour in blotches.
Vitiligo occurs when pigment-producing cells die or stop functioning.
Loss of skin colour can affect any part of the body, including the mouth, hair and eyes. It may be more noticeable in people with darker skin.
Treatment may improve the appearance of the skin but doesn’t cure the disease.
Almost 1 percent of the world’s population has vitiligo. When you have vitiligo, the cells that are responsible for your skin colour are destroyed. These cells, called melanocytes, no longer produce skin pigment, called melanin. Once the cells no longer produce melanin, areas of your skin will lose colour or turn white.
Areas of lost pigment can develop anywhere on your body, including:
- sun-exposed areas like the hands, feet, arms, and face
- within the hearing system of the ear
- inside the mouth or other mucus membranes
- back of the eye
Your hair may also turn grey or white if the areas involved have hair.
Even though vitiligo can affect many different parts of the body, it’s not contagious. A person with vitiligo can’t transmit it to someone else.
Symptoms of Vitiligo
The primary symptom of vitiligo is white patches on the skin. And it can affect any area of the body, even the areas around your eyes. The patches can be large or small and appear as one of the following patterns:
Segmental or focal: White patches tend to be smaller and appear in one or a few areas. When vitiligo appears in a focal or segmental pattern, it tends to stay in one area one side of the body. Many times it continues for a year or so, then stops. It also progresses slower than generalized vitiligo.
Non-segmental or generalized: Widespread white patches appear symmetrically on both sides of the body. This is the most common pattern and can affect pigment cells anywhere on the body. If often starts and stops many times over the course of a person’s lifetime. There’s no way to determine when, if, or how fast patches will develop.
One study showed that 75 percent of people with vitiligo have loss of pigment on the hands and face. Other common areas are in body folds, like the skin under your arms and around your groin.
Psychological effects of vitiligo
Research shows that vitiligo can cause significant psychological effects. Scientific reviews show that over 50 percent of people with vitiligo reported negative effects on their relationships. Some people reported thinking about their condition all day, especially due to the unpredictability of it.
They also reported:
- feeling like their condition is a disfigurement
- avoiding physical activities
- withdrawing from events
- emotional burden
If you have vitiligo and are feeling any of these negative effects, talk to your doctor or someone who cares about you. It’s also important to learn as much as you can about the disorder. This can help alleviate stress you may have about your condition or treatment options.
Diagnosis of Vitiligo
During your visit, your doctor will perform a physical exam, ask about your medical history, and conduct lab tests. Be sure to report any events that could be contributing factors, like recent sunburns, premature graying of your hair, or any autoimmune diseases you may have. Also let your doctor know if anyone else in your family has vitiligo or other skin diseases.
Others questions your doctor may ask are:
- Are any areas getting better or worse?
- Does anyone in your family have an autoimmune disorder?
- Have you tried any treatments already?
- Where on your body did it first start?
- Does anyone in your family have vitiligo?
Your doctor may also use an ultraviolet lamp to look for patches of vitiligo. The lamp, also known as Wood’s lamp, helps your doctor look for differences between vitiligo and other skin conditions.
At times your doctor may want to take a sample of skin, known as a biopsy. The lab will look at these samples. Skin biopsies can show if you still have pigment-producing cells in that area of your body. Blood tests can help diagnose other problems that may go along with vitiligo, such as thyroid problems, diabetes or anemia.
Risk Factor for Vitiligo
It’s unknown exactly what causes vitiligo. The condition doesn’t appear to be inherited. Most people with vitiligo don’t have a family history of the disorder. But family history of vitiligo or other autoimmune conditions may increase your risk even though it doesn’t cause vitiligo.
Another risk factor may be having genes associated with vitiligo, including NLRP1 and PTPN22
Most researchers believe that vitiligo is an autoimmune disorder because your body is attacking your own cells. But it’s also unclear how your body attacks your pigment cells. What is known is that about 20 percent of people with vitiligo also have one other autoimmune disorder. Depending on the population, these disorders can include the following, from most common to least common:
- thyroiditis, caused by an improperly functioning thyroid
- type 1 diabetes
- pernicious anemia, an inability to absorb vitamin B-12
- scleroderma, a disorder of the connective tissue of the body
- Addison’s disease
- rheumatoid arthritis
- alopecia areata, or baldness
Some experts also report vitiligo appearing after incidents of:
- exposure to toxins and chemicals
- high levels of stress
- severe sunburns or cuts
Treatments for Vitiligo
Treatments for vitiligo aim to restore colour balance to your skin. Some treatments aim to add pigment while others remove it. Your options will vary according to:
- how many patches you have
- how widespread the patches are
- the severity of your condition
- the location and size of your patches
- how you respond to treatment
The types of treatments include medical, surgical, or a combination of both. But not all treatments work for everyone and some may cause unwanted side effects.
Always contact your doctor if you start experiencing side effects due to a treatment. They may readjust your dosage or provide alternatives.
Surgical options are available when medications and light therapy don’t work. Your doctor can recommend surgical options if you have had no new or worsening white patches in the last 12 months, and your vitiligo wasn’t caused by sun damage.
The types of surgery include:
Skin grafting: Your surgeon removes healthy, pigmented skin and transfers it to depigmented areas. Risks of skin grafting include infection, scarring, or failure to re-pigment. Skin grafting using blisters is another option that has less risks. For this procedure, your doctor will create blisters on your unaffected skin and transfer the top of the blister to another area.
Melanocyte transplants: Your doctor removes melanocytes and lets them grow in a lab. Then, the cells are transplanted to the depigmented areas of skin.
Micropigmentation: Your doctor will tattoo pigment into your skin. This is best for the lip area, but it may be hard to match your skin’s colour.
You’ll usually need at least three months of treatment before you can see its effects. Medical treatments include:
Topical creams: Some creams, including corticosteroids, can help return colour to white patches in the initial stages. Others help slow the growth. You’ll need a prescription for creams that are strong enough, but they can also cause side effects when used for a long time. Side effects can include:
- excess hair growth
- skin irritation
- skin shrinkage
Oral medications: Some medications like steroids and certain antibiotics may be effective in treating vitiligo. These are only available by prescription.
Psoralen and ultraviolet A (PUVA) therapy: This treatment combination requires you to take psoralen as a pill or apply it to your skin as a cream. Then your doctor exposes you to UVA light to activate the drugs which help restore colour to your skin. Afterwards, you’ll need to minimize sun exposure and wear protective sunglasses. PUVA does have side effects that can include:
Narrow band UVB light: This is an alternative to traditional PUVA therapy. This treatment provides a more focused type of light therapy often leading to fewer side effects. It can also be used as part of a home treatment program under a doctor’s supervision.
Excimer laser treatment: This treatment helps with small areas of patches and takes less than four months, two to three times per week.
Depigmentation: Your doctor may recommend depigmentation if more than 50 percent of your body is affected and you want to balance your skin. This often is a solution when treatments to return pigment to your skin have failed. Depigmentation focuses on fading the rest of the skin to match the areas that have lost colour. It can take up to two years for treatment to be effective. You’ll apply a medication like monobenzone as directed by your doctor. The biggest side effect of depigmentation is inflammation. This treatment tends to be permanent and you’ll be extra sensitive to sunlight.
Other therapies and management options
Even if you are undergoing medical treatment for vitiligo, the results can be slow. So, you may want to incorporate the following:
Sunscreen: Reducing sun expose can help keep your skin even. Tanning will add contrast to your skin, making affected areas more visible. The higher the SPF, the more protection you receive. It is important to use sunscreen as areas without pigmentation are susceptible to sunburns and sun damage.
Cosmetics: Makeup or self-tanning lotions can help even out your skin tone. You may prefer self-tanning lotions because the effect lasts longer, even with washing.
Managing mental health: One study suggests that medication and psychotherapy can improve your quality of life. Talk to your doctor if you are experiencing negative mental health effects.
Research shows that people with vitiligo tend to develop issues around emotional stress and self-esteem. One study also found that parents of children with vitiligo report lower for quality of life. But vitiligo isn’t contagious nor does it cause any negative physical effects. People with vitiligo can live a healthy, active life.
It is important to find a therapist who understands this skin condition and its impact on mental health. Early, but limited, studies of individual cognitive behavior therapy (CBT) and vitiligo suggest it can help with:
- maintaining self-esteem
- preventing depression
- improving overall quality of life
Along with your family and friends, a vitiligo support group is a great source of support. These groups give patients the opportunity to express themselves and meet others with the same condition. You can also look at the #vitiligo hashtag on social media for stories of people embracing their appearance. One example is fashion model and activist Winnie Harlow who calls herself a “vitiligo spokesmodel.”
Complications of Vitiligo
The good news is that many times vitiligo has few physical side effects on the body. The most serious complications may affect the ears and eyes, but these aren’t common. The primary physical effect is that the loss of pigment that increases your risk for sunburn. You can protect your skin by applying sunscreen with a SPF of 30 and wearing sun protective clothing.