What is vitiligo?
Vitiligo is a persistent or chronic condition in which areas of skin lose their normal pigment and become very pale or pink. It is common, affecting about 1% of the world’s population. It can start at any age after birth, but more than half of the people affected by it are before 20 years of age.
The extent of the condition is unpredictable, varying from single small patches to total loss of skin color. In most people, it tends to change slowly, with periods of stability often lasting several years. The pigment may return in some patients, but is not guaranteed, and seldom returns completely.
What causes vitiligo?
The pigment that gives your skin its normal color is called melanin and is made by cells known as melanocytes. In the patches of vitiligo, the melanocytes are inactive but still present. The reason for this is not fully understood.
However, vitiligo is considered to be an ‘autoimmune’ condition in which the body’s immune system rejects some of its own cells (melanocytes in the case of vitiligo). As a result, thyroid disease and other autoimmune conditions are more common in individuals with vitiligo.
Repeated trauma such as rubbing or scratching the skin may trigger vitiligo. Vitiligo affects men and women of all races equally but is more noticeable in people with dark skin color. It is not infectious. There is no medical evidence of any link between diet or smoking and vitiligo.
Is vitiligo hereditary?
Yes, vitiligo has a genetic basis, although less than half of those with vitiligo know of someone in their family who also has it. If you have vitiligo, it does not necessarily follow that your children will develop it.
What are the symptoms of vitiligo?
Vitiligo is not usually itchy or sore, but some people experience some irritation of the skin before a new vitiligo patch appears. Sunlight may cause sunburn to exposed areas. Some people may feel embarrassed by this as it will stand out more obviously when the surrounding skin is tanned or in naturally dark-skinned individuals.
What does vitiligo look like?
Vitiligo consists of irregularly shaped patches of skin that lack the normal melanin pigmentation, and are thus wholly very pale, pink or almost white. It is often symmetrical, affecting both sides of the body, although less commonly, it can be localized to one part of the body. The skin otherwise feels entirely normal.
The most common sites for vitiligo are the hands and face, around body openings (the eyes, nostrils, mouth, umbilicus, and genital regions), and within body folds such as the underarms and groin.
When hair-bearing skin is involved, the hair may lose its pigment and appear white. Repigmentation (recovery) often commences around hair follicles, initially giving the skin a speckled appearance.
How will vitiligo be diagnosed?
The diagnosis is usually easily made by your dermatologist. Occasionally, examination under an ultraviolet lamp is helpful to confirm affected areas, especially in light-skinned people. Once the diagnosis of vitiligo is made, your doctor may take a blood sample to check for thyroid disease and other autoimmune conditions. Clinical photographs may sometimes be taken by your doctor to monitor vitiligo and the effect of any treatment you receive.
Can vitiligo be cured?
There is no cure for vitiligo. Although treatment may help restore the color, it cannot prevent its spread or recurrence, and repigmentation (recovery) may not be permanent.
How can vitiligo be treated?
Several treatment options can be discussed with your dermatologist.
The application of a potent or very potent corticosteroid anti-inflammatory cream or ointment to areas of vitiligo may restore some pigment. Side effects, such as thinning of the skin and stretch marks, are a risk with continued use. Short courses of oral steroids can sometimes be considered but may be associated with side effects such as weight gain, skin thinning, mood changes, and cataracts.
Other topical preparations
Other types of anti-inflammatory creams and ointments, such as calcineurin inhibitors and vitamin D analogs, may also restore pigment in some patients. These topical treatments will help avoid the corticosteroid side effect of skin thinning.
This treatment involves exposing affected skin to artificial ultraviolet light. Phototherapy may be helpful in a proportion of patients with vitiligo. However, treatment often needs to be prolonged (lasting at least several months). Full repigmentation is unusual, and depigmentation after phototherapy can occur.
Areas such as the fingertips and the skin around the lips are less likely to improve (see Patient Information Leaflet on Phototherapy). Phototherapy may also be used in combination with topical or oral corticosteroid treatments.
This process involves transplanting small areas of healthy skin into areas of stable vitiligo. This method of treatment is still being developed and is not yet in general use.
Some areas of vitiligo have improved from treatment with a laser called the Excimer laser. This treatment appears to work best on vitiligo that has not changed for a long time and affects relatively small areas of skin. Laser treatment can sometimes be used in combination with topical treatments.
Removing the remaining pigment
If vitiligo has spread very widely (more than 50% of the body) or involves large areas of the face or hands, in exceptional circumstances, it may be reasonable to consider removing the small amounts of pigmented areas of skin using bleaching chemicals such as hydroquinone.
The emotional, social, and medical implications must be carefully discussed before this treatment is used, and it should only be undertaken with specialist supervision for psychological therapies. Professional help with developing coping mechanisms may be helpful for some people with vitiligo or their carers, e.g., parents.
Advice from experts about skin camouflage is now widely available. There are right quality camouflage products in a range of colors that are water-resistant and less likely to rub off. Your GP or dermatologist can advise or refer you to a camouflage service for this. Careful use of fake suntans can be useful to make areas of vitiligo less noticeable.