What Is Vitiligo?
Vitiligo is the patchy depigmentation of skin due to loss of melanocytes in the skin. Melanocytes, located in the epidermis (the surface layer of the skin) and eyes, are cells that produce melanin, a dark pigment that gives skin its color and protects against ultraviolet radiation. People with darker skin produce more melanin than those with pale skin.
In vitiligo, melanocytes are lost and white spots develop at these locations. Some people may exhibit just a few small white or depigmented patches, while others may have widespread depigmentation.
The cause of vitiligo is unknown; however, it may be an autoimmune disorder, in which the body’s defenses mistakenly destroy some of its own cells—in this case, melanocytes. People of any skin color may be affected, but the condition is more apparent in those with darker skin. Vitiligo is a relatively common condition that does not pose a health risk, but it may be quite psychologically distressing.
What Causes Vitiligo?
- Vitiligo may be an autoimmune disorder. The underlying cause is unknown, but hereditary factors play a role.
- Vitiligo may be associated with other disorders such as autoimmune thyroid disease, diabetes mellitus, adrenal insufficiency and pernicious anemia.
- Skin injury, burns and inflammatory skin disorders may trigger the local loss of pigment in people with vitiligo.
Symptoms of Vitiligo
- Irregular patches of depigmented, white skin. Patches are commonly located on the hands, face, groin and folds of skin, and may be symmetrically distributed on the body. Patches may slowly spread to cover large areas of the body.
- White hairs within depigmented patches
- There is no known way to prevent vitiligo.
- Patient history should include any exposure to caustic chemicals or solvents. (These can cause chemical leukoderma or chemical pigment destruction, which are different from vitiligo.)
- Diagnosis can usually be made solely by observation of characteristic skin changes.
- A special light (Wood’s lamp) may be shined on the skin in a dark room to identify vitiliginous patches in fair-skinned patients.
- Blood tests can be performed to detect for signs of autoimmune diseases.
How to Treat Vitiligo
- To keep skin as evenly pigmented as possible, try to avoid exposure to direct sunlight between the hours of 10 a. m. and 2 p. m. Block the sun’s rays by wearing protective clothing, such as hats and long sleeves, whenever possible. Apply a sunscreen lotion that has a sun protection factor (SPF) of 30 or higher. Reapply often, especially after swimming or perspiring heavily.
- Over-the-counter cosmetic creams and dyes are available to cover depigmented areas with a color that matches your skin tone.
- Photochemotherapy (PUVA) may be used to try to stimulate skin repigmentation. PUVA is controlled exposure to ultraviolet A (UVA) light, in combination with psoralen (P), a drug that increases the skin’s sensitivity to UVA wavelengths. A minimum of two sessions each week is necessary and many sessions may be required before any improvement is seen, if it occurs at all.
- Narrowband UVB phototherapy can help treat small areas of vitiligo.
- Creams containing fluorinated steroids may be prescribed to stimulate repigmentation of the skin.
- In cases of widespread vitiligo, bleaching the unaffected skin with hydroquinone to match depigmented areas may be considered.
When to Call a Doctor
- Make an appointment with a doctor if you find mere cosmetic coverage of vitiliginous patches of skin to be unsatisfactory.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media