Vitiligo

Most people who develop vitiligo will have it for the rest of their lives. It is very rare for vitiligo to completely improve.

WHO GETS VITILIGO?

People of all races and skin colors get vitiligo. About half of those who develop vitiligo do so by age 20, while nearly 95 percent develop vitiligo by age 40. Vitiligo is not contagious. Research shows that about 25 percent of people living with vitiligo have a blood relative who has vitiligo.

WHAT CAUSES VITILIGO?

Vitiligo develops when cells called melanocytes, which give our skin and hair color, are destroyed or stop producing pigment.

Scientists do not completely understand why this happens to melanocytes. The most common type of vitiligo, generalized vitiligo, may be an autoimmune disease.

An autoimmune disease develops when the body mistakes a part of itself as foreign. When the body mistakes melanocytes as foreigners, the immune system begins to attack and destroy these cells.

HOW IS VITILIGO DIAGNOSED?

A board-certified dermatologist diagnoses vitiligo by reviewing your medical history and examining your skin. The doctor may use a special light called a Wood’s lamp to examine areas of the skin that have lost pigment. Other medical tests are sometimes necessary.

Vitiligo on the hands

If the diagnosis is vitiligo, blood tests to look for autoimmune disorders may be recommended.

WHAT ARE THE TYPES OF VITILIGO?

• This is the most common type of vitiligo. The skin usually loses color equally on both sides of the body. Color loss commonly affects the arms and legs, including the hands, fingertips and feet, as well as the genitals and areas around the eyes or mouth; however, any part of the body can be affected. In the beginning, color loss may be rapid. This is often followed by a period of little or no color loss.
• This type involves scattered white patches in only one area of the body, such as the chest, back, abdomen, or one arm or leg.
• This type causes color loss on one part of the skin, often in the location of the nerve fibers that pass through that area of the skin. Hair color may also be lost in the involved area. Often, a bit of hair on the head, an eyelash or eyebrow turns white. Color loss often occurs for a year or two and then stops.
• Color loss occurs only on the head, hands and feet.
• Color loss occurs on most of the body.

HOW IS VITILIGO TREATED?

The goal of most vitiligo treatments is to help re-pigment the affected skin, although this isn’t always effective. Research shows that for people living with vitiligo, an even skin tone can greatly improve both physical and psychological well-being.

Some treatments work best on certain types of vitiligo or on certain areas of the body.

The type of treatment that your dermatologist recommends will depend on many factors, including how much of your skin is affected, your age and your general health.

Topical treatments

These prescription medicines are applied to your skin at home. These may include a topical corticosteroid, tacrolimus ointment, pimecrolimus cream or calcipotriol (a vitamin D compound). Topical medications usually work slowly to return color to the skin.

To return color to the skin more quickly, your dermatologist may combine treatments. For example, your dermatologist may prescribe both a topical corticosteroid and calcipotriol.

These creams and ointments are powerful treatments, and your dermatologist will want to monitor your skin carefully. Be sure to keep all appointments with your dermatologist.

Light therapy

This type of treatment exposes your body to narrowband ultraviolet B, which can help return color to your face and trunk. This treatment does not work as well to return color to the hands and feet. It requires several visits a week for many months in which you will either stand in a light box or receive more targeted laser treatments. This treatment works slowly.

Vitiligo on the face

To return color to the skin more quickly, your dermatologist may combine this treatment with topical therapy.

Another light therapy used to treat vitiligo is PUVA. This treatment combines psoralen, a medicine that can be applied to the skin or taken in pill form, with UVA light. Psoralen makes the skin more reactive to light. PUVA can be 75 percent effective in returning color to the skin on the face, trunk, upper arms and upper legs, but in many instances the response is only partial. The hands and feet tend to respond poorly.

PUVA requires treatments given two to three times a week at a medical center. PUVA treatments should be given under a board-certified dermatologist’s close supervision due to the potential for serious side effects.

Skin graft

During this surgical procedure, healthy skin that has not lost color is removed and placed over skin that has lost color. While it is not a common treatment option, a skin graft can produce excellent results when performed by an experienced board-certified dermatologist. It tends to be most effective for localized vitiligo.

Depigmentation

This treatment, which is rarely used, is only an option for patients who have already lost most of their skin color. Depigmentation removes the remaining color from the skin, leaving you with more even-colored skin. To remove the remaining color, you must apply a prescription cream once or twice a day to the skin that still has normal color. This must be done for one to two years.

Depigmentation can be an effective way to achieve one skin color. Depigmentation is permanent, so talk to your dermatologist about the pros and cons.

HOW IS VITILIGO TREATED IN CHILDREN?

Vitiligo often develops at a young age. Children can be treated, but they have fewer treatment options because the treatments are so strong. Some prescription creams and ointments can be used. Light therapy is another option. NB-UVB light treatment is generally only recommended after 12 years of age. Even at that age, the risks and benefits must be carefully considered. The PUVA light therapy that requires a pill is not recommended for children.

CAN I USE MAKEUP, SELF-TANNER OR SKIN DYES TO COLOR MY SKIN?

Applying makeup, self-tanner or skin dyes to skin that has lost color provides instant results, making this option appealing. It also avoids possible side effects of treatment, but there are drawbacks. Some products require daily application, which can be time-consuming. It can also take practice to get natural-looking results. Many camouflage makeups, self-tanners and dyes are available.

Your dermatologist can recommend products to conceal vitiligo. If you opt to use a self-tanner, it is important to know that some contain a chemical called dihydroxyacetone. This chemical can effectively color the skin, but it also interferes with some medicines used to treat vitiligo. If you use self-tanners and decide to see a dermatologist for treatment, be sure to tell the dermatologist that you are using these products.

Vitiligo on the legs

Parents of children with vitiligo should discuss these options with their dermatologist.

HOW DO I PROTECT MY SKIN FROM THE SUN?

If you have vitiligo, it is important to protect your skin from the sun’s damaging UV rays. Generously apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to all exposed skin whenever you will be outdoors. Apply sunscreen 15 minutes before going outside and reapply it every two hours, or after swimming or sweating.

In addition to applying sunscreen, you should also:

• Seek shade. The sun’s rays are strongest between 10 a.m. and 2 p.m. If your shadow appears to be shorter than you are, seek shade.
• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, when possible.
• Avoid tanning. If you have light skin, tanning – both indoors or out – may make vitiligo more pronounced because it can increase the contrast between your natural skin color and the light patches.

A board-certified dermatologist is a medical doctor who specializes in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions. To learn more about vitiligo or to find a board-certified dermatologist in your area, visit aad.org/vitiligo or call toll-free (888) 462-DERM (3376).

All content solely developed by the American Academy of Dermatology.Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

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