What Is Vitiligo?

Vitiligo can cause several symptoms, including:

• white patches on the skin
• premature graying or whitening of the hair, eyebrows, facial hair, or eyelashes
• loss of pigment in the mucous membranes, including the inner lining of the nose and lips

One 2016 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.

However, the specific areas that are affected may vary depending on the type of vitiligo. According to a 2020 review, types of vitiligo include:

• Universal vitiligo. This type of vitiligo affects most of the surfaces of the skin.
• Segmental vitiligo. White patches appear on one side of the body. Many times it continues for a year or so, then stops. It also progresses slower than generalized vitiligo.
• Generalized vitiligo. 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.
• Focal vitiligo. Patches tend to be smaller and occur in only a few areas of the body.
• Acrofacial vitiligo. This form of vitiligo primarily affects the face, hands, and sometimes feet.

It’s unknown exactly what causes vitiligo. The condition doesn’t appear to be inherited, and many people with vitiligo don’t have a family history of the disorder. However, the National Institute of Arthritis and Musculoskeletal and Skin Diseases suggests that having a family history of vitiligo or other autoimmune conditions could increase your risk.

According to a 2018 review, 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. A 2016 study found that about 20 percent of people with vitiligo also have one other autoimmune disorder.

Many autoimmune diseases may be associated with vitiligo, including:

• thyroiditis, caused by an improperly functioning thyroid
• lupus
• psoriasis
• alopecia areata, or baldness
• type 1 diabetes
• pernicious anemia, an inability to absorb vitamin B12
• Addison’s disease
• rheumatoid arthritis
• scleroderma, a disorder of the connective tissue of the body

Some experts also report vitiligo appearing after incidents of:

• severe sunburns or cuts
• exposure to toxins and chemicals
• high levels of stress

Many times, vitiligo has few physical effects on the body. The most serious complications are in the ears and eyes, but these aren’t common.

The primary physical effect is that the loss of pigment increases your risk of sunburn. You can protect your skin by applying sunscreen with a sun protection factor (SPF) of 30 or higher, and wearing sun protective clothing.

Psychological effects

Research shows that vitiligo can cause significant psychological effects. According to a 2016 review, 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 its unpredictability.

They also reported:

• avoiding physical activities
• withdrawing from events
• feeling like their condition is a disfigurement
• depression
• anxiety
• emotional burden

If you have vitiligo and are feeling any of these negative effects, talk with 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.

Talk with your doctor if you experience any of the following symptoms:

• white patches or loss of pigmentation in the skin
• premature graying or whitening of the hair on the scalp, face, eyelashes, or eyebrows
• loss of color in the inner lining of the nose or mouth

Vitiligo doesn’t have a cure, but early treatment can help slow discoloration and restore pigmentation to any affected areas of the skin.

Because vitiligo is often associated with other conditions, treatment can also help identify and address any underlying health issues.

During your visit, your doctor will perform a physical exam, ask about your medical history, and conduct lab tests.

Be sure to report anything that could be a contributing factor, 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:

• Where on your body did it first start?
• Does anyone in your family have vitiligo?
• Does anyone in your family have an autoimmune disorder?
• Have you tried any treatments already?
• Are any areas getting better or worse?

Your doctor may also use an ultraviolet lamp to look for patches of vitiligo. The lamp, also known as a 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. A 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 conditions, type 1 diabetes, or anemia.

Treatments for vitiligo aim to restore color balance to your skin. Some treatments aim to add pigment, while others remove it. Your options will vary according to:

• the severity of your condition
• the location and size of your patches
• how many patches you have
• how widespread the patches are
• how you respond to treatment

For vitiligo, you might receive medical treatments, surgical treatments, or a combination of both. However, 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 adjust your dosage or provide alternatives.

Medical

You’ll usually need at least 3 months of treatment before you can see its effects. According to a 2018 review, medical treatments include:

• Topical creams. Some creams, including corticosteroids and calcineurin inhibitors (anti-inflammatory creams), can help return color 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 skin atrophy, thinning, excess hair growth, and skin irritation.
• Oral medications. Some medications like steroids may be effective in treating vitiligo. These are only available by prescription.
• Psoralen and ultraviolet A (PUVA) light 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 color to your skin. Afterwards, you’ll need to minimize sun exposure and wear protective sunglasses. PUVA does have side effects that can include sunburn, nausea, itching, and hyperpigmentation.
• Narrowband ultraviolet B light therapy. 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 4 months, two to three times per week.
• Depigmentation. According to a 2017 study, 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 color. You’ll apply a medication like monobenzone as directed by your doctor. Though it can take up to 2 years to be effective, this treatment tends to be permanent. In addition to causing inflammation, it can also increase sensitivity to sunlight.

Surgical

Surgical options are available when medications and light therapy don’t work. Your doctor can recommend surgical options if your vitiligo patches are stable, and your vitiligo wasn’t caused by sun damage.

According to a 2021 review, the types of surgery include:

• Skin grafting. Your surgeon transfers healthy, pigmented skin to depigmented areas. Risks include infection, scarring, or failure to repigment. Skin grafting using blisters is another option with fewer risks. This option involves creating blisters on unaffected skin and transferring the top of the blister to another area.
• Melanocyte transplants. Your doctor removes a specimen of healthy tissues, cultures the melanocytes, and then transplants the cells to depigmented areas.
• 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 color.

Other therapies and management options

Even if you are receiving 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. It is important to use sunscreen with a high SPF, as areas without pigmentation are susceptible to 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. Some 2018 research suggests that medication and psychotherapy can improve your quality of life. Talk with your doctor if you are experiencing negative mental health effects.

Research shows that people with vitiligo tend to experience emotional stress and low self-esteem. One 2015 study also found that parents of children with vitiligo report lower quality of life.

However, vitiligo isn’t contagious, and it typically doesn’t cause any negative physical effects. People with vitiligo can live healthy, active lives.

It is important to find a therapist who understands this skin condition and its impact on mental health. A 2018 review of early, but limited, studies suggests that individual cognitive behavior therapy (CBT) 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 members 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.”

Research on vitiligo has increased in the past years. Newer technology allows for advances in genetic research so that we can understand how vitiligo works.

Understanding how vitiligo is triggered and how its process interacts with other organ systems can help researchers develop new treatments.

Other studies on vitiligo are looking at how trauma or stress trigger vitiligo, how genetics affects vitiligo, and how the chemical signals of the immune system play a role.

You can also see the latest clinical trials over at ClinicalTrials.gov.