Overview

Vitiligo (vit-ih-LIE-go) 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 and the inside of the mouth.

Normally, the color of hair and skin 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. It can be stressful or make you feel bad about yourself.

Treatment for vitiligo may restore color to the affected skin. But it does not prevent continued loss of skin color or a recurrence.

Symptoms

The main sign of vitiligo is patchy loss of skin color. Usually, the discoloration first shows on sun-exposed areas, such as the hands, feet, arms, face and lips.

Vitiligo signs include:

• Patchy loss of skin color
• Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard
• 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)

Vitiligo can start at any age, but 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.

It's difficult to predict how your disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of your skin. Rarely, the skin gets its color back.

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.

Causes

Vitiligo occurs when pigment-producing cells (melanocytes) die or stop producing melanin — the pigment that gives your skin, hair and eyes color. The involved patches of skin become lighter or white. Doctors don't know why the cells fail or die. It may be related to:

• A disorder in which your immune system attacks and destroys the melanocytes in the skin
• Family history (heredity)
• A trigger event, such as sunburn, stress or exposure to industrial chemicals

Complications

People with vitiligo may be at increased risk of:

• Social or psychological distress
• Sunburn and skin cancer
• Eye problems, such as inflammation of the iris (iritis)
• Hearing loss

Diagnosis

Medical history and exam

If your doctor suspects you have vitiligo, he or she will ask about your medical history, examine you and try to rule out other medical problems, such as dermatitis or psoriasis. He or she 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
• Draw blood for lab tests to look for underlying autoimmune conditions, such as anemia or diabetes

Treatment

Many treatments are available to help restore skin color or even out skin tone. Results vary and are unpredictable. Some treatments have serious side effects. So your doctor may suggest that you first try improving the appearance of your skin by applying self-tanning products or makeup.

If you and your doctor decide to treat your condition with a drug, surgery or therapy, the process may take many months to judge its effectiveness. And you may have to try more than one approach or a combination of approaches before you find the treatment that works best for you.

Even if treatment is successful for a while, the results may not last or new patches may appear.

Medications

No drug can stop the process of vitiligo — the loss of pigment cells (melanocytes). But some drugs, used alone or with light therapy, can help restore some skin tone.

• Creams that control inflammation. Applying a corticosteroid cream to affected skin may help return color, 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.

  Milder forms of the drug may be prescribed for children and for people who have large areas of discolored skin.

• 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. However, the Food and Drug Administration has warned about a possible link between these drugs and lymphoma and skin cancer.

Therapies

• Combining psoralen and light therapy. This treatment combines a plant-derived substance called psoralen with light therapy (photochemotherapy) to return color to the light patches. After you take psoralen by mouth or apply it to the affected skin, you're exposed to ultraviolet A (UVA), UVB light or excimer light. These approaches tend to have better results than just medication or just light. You may need to repeat treatments up to three times a week for six to 12 months.

• Removing the remaining color (depigmentation). This therapy may be an option if your vitiligo is widespread and other treatments haven't worked. A depigmenting agent is applied to unaffected areas of skin. This gradually lightens it so that it blends with the discolored areas. The therapy is done once or twice a day for nine months or longer.

  Side effects can include redness, swelling, itching and dry skin. Depigmentation is permanent, and you'll always be extremely sensitive to sunlight.

Surgery

Surgery may be an option for you if light therapy doesn't work. Surgery can also be used with those therapies. The goal of the following techniques is to even out your skin tone by restoring color.

• 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. He or she then removes 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. And the skin damage caused by suctioning may trigger another patch of vitiligo.

• Tattooing (micropigmentation). In this technique, your doctor uses a special surgical instrument to implant pigment into your skin. It's most effective in and around the lips in people with darker complexions.

  Drawbacks include difficulty matching the skin color and potential for the tattooing to trigger another patch of vitiligo.

Potential future treatments

Treatments being studied include:

• A drug to stimulate color-producing cells (melanocytes). Called afamelanotide, this potential treatment is implanted under the skin to promote the growth of melanocytes.
• A drug that helps control melanoctyes. Prostaglandin E2 is being tested as a way to restore skin color in people with localized vitiligo that isn't spreading. It's applied to the skin as a gel.
• A drug that reverses loss of color. Tofacitinib, an oral drug typically used to treat rheumatoid arthritis, has shown some potential as a treatment for vitiligo.

Lifestyle and home remedies

The following self-care tactics may help you care for your skin and improve its appearance:

• Protect your 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. Apply sunscreen generously and reapply every two hours — or more often if you're swimming or sweating.

  You can also seek shade and wear clothing that shields your skin from the sun. Don't use tanning beds and sunlamps.

  Protecting your skin from the sun helps prevent sunburn and long-term damage. A bad sunburn can make your 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. You may need to try several brands of makeup or self-tanners to find one that blends well with your normal skin tone. The coloring of self-tanning products doesn't wash off, but it gradually fades over several days. If you use a self-tanner, select one that contains dihydroxyacetone, as it is approved by the Food and Drug Administration.
• 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.

Alternative medicine

Limited studies show that the herb Ginkgo biloba may return skin color in people with vitiligo. Other small studies show that alpha-lipoic acid, folic acid, vitamin C and vitamin B-12 plus phototherapy may restore skin color for some people.

As with any over-the-counter (nonprescription) treatment, check with your doctor before trying alternative medicine therapies to be sure they won't interact badly with other treatments you may be using.

Coping and support

You may feel stressed, self-conscious, sad, ashamed or even devastated by the change in your appearance caused by vitiligo. You may feel that the condition limits your ability to go about your daily activities, especially if it's widespread or affects visible areas of your body, such as the face, hands, arms and feet.

These tips may help you cope with vitiligo:

• Make a good connection. Find a doctor who knows a lot about the condition. A dermatologist is a doctor who specializes in the care of skin.
• Learn all about it. Find out as much as you can about the condition and your treatment options so that you can help decide what steps to take.
• Communicate your feelings. Let your doctor know if you're feeling depressed. He or she can refer you to a mental health provider who specializes in helping people with depression.
• Talk with others. Ask your doctor about psychotherapy or support groups in your area for people with vitiligo.
• Confide in loved ones. Seek understanding and support from your family and friends.

Preparing for your appointment

You're likely to start by seeing your primary care doctor. You may then be referred to a specialist in skin disorders (dermatologist).

Here's some information to help you prepare for your appointment.

What you can do

• Review your family medical history. Find out if anyone in your family has vitiligo, a thyroid condition or a disease in which the immune system attacks healthy tissues in the body (autoimmune disease).
• List relevant personal information, such as recent major stressful events, life changes, sunburns and rashes.
• List any medications, vitamins and supplements you're taking, including doses.
• Make note of questions you'd like to ask your doctor, which will help you make the most of your limited time together.

Some basic questions to consider include:

• What's the most likely cause of my symptoms?
• What are other possible causes?
• Do I need any tests?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• What side effects can I expect from treatment?
• Can I do anything to help, such as avoid the sun at certain times or wear a specific sunscreen?
• Can you recommend a product to conceal the discolored patches?
• Do you have brochures or other printed material I can take home? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a few questions, such as:

• When did you begin noticing light patches on your skin?
• Did you have a sunburn or skin rash before you noticed the patches?
• Are you sensitive to the sun?
• Do the discolored patches itch or cause any other symptoms?
• Have you ever had this type of change before?
• Does anyone in your family have vitiligo, a thyroid condition or an autoimmune disease?
• What is your occupation, and what are your hobbies? Are you exposed to any harsh chemicals in either?
• Does this condition affect your quality of life?

What you can do in the meantime

While you're waiting to see the doctor, limit your sun exposure and use a broad-spectrum sunscreen with an SPF of at least 30. If you're feeling self-conscious about the changes in your skin, use makeup or a self-tanning product to cover the affected areas.