Vitiligo

What is vitiligo?

Vitiligo is a disease that causes areas of skin to lose color, resulting in spots and patches of lighter skin. Some people develop a few spots, while others have more widespread color loss. Dermatologists offer treatment that may restore lost skin color.

Is vitiligo contagious? No

People of any skin color can develop vitiligo.  The contrast between someone’s natural skin color and the lighter patches is greater when the person has a darker skin tone or a tan.

Vitiligo on hand of Black person and hand of white person

How does vitiligo start and is it contagious?

No, vitiligo is not contagious.  It usually begins with a few small lighter patches that develop on the skin. These patches may stay the same size for years or grow larger. New patches can appear on the skin. The new patches may be close to existing patches or far from them.

  • If you develop a few spots or patches that appear in one or a few places on your body, dermatologists refer to this as localized vitiligo.
  • When vitiligo causes scattered patches of color loss on different areas of the body, it’s called generalized vitiligo.
  • While rare, some people lose most of their skin color. This is called universal vitiligo.

There’s no way to predict how much color someone’s skin will lose. There’s also no way to know who will have patches that get larger or where new patches will appear.  What you see when vitiligo begins is also affected by the type of vitiligo you have. The most common type, non-segmental vitiligo, tends to spread slowly with new patches developing off and on throughout a person’s life.

Non-segmental vitiligo - When a person has non-segmental vitiligo, patches tend to appear on both sides of the body like both knees or both hands.

Segmental vitiligo - People who have this type tend to see rapid color loss on one side of the body. After 6 to 12 months, segmental vitiligo tends to stabilize, meaning that the color loss stops. Once it stops, most people with segmental vitiligo don’t develop new patches or spots.  Also called unilateral vitiligo, this type causes the skin to lose color on one side or part of the body.

Mixed type vitiligo is more rare and people with this type develop both segmental vitiligo and color loss beyond the area with segmental vitiligo.

Where does vitiligo appear on the body?

Vitiligo can develop anywhere on a person's skin. When vitiligo begins, the patches usually appear on the:

  • Face
  • Arms
  • Hands
  • Feet

In time, the spots and patches can grow, and vitiligo can appear on other areas of a person’s body. Some people lose color in areas called mucous membranes, which includes the inside of the mouth or nose and the genitals.

Vitiligo can also affect the hair, causing white or prematurely gray hair.

Some people lose some of their eye color and see light spots on the colored part of an eye. Vitiligo can also develop inside your ear and may affect your hearing.

Causes

Vitiligo runs in families. However, while having a close blood relative with vitiligo increases your risk of developing it, not everyone who has vitiligo in their family develops this disease.  A number of genes are involved. Vitiligo develops when changes occur in these genes, and the changes happen in the right combination.

People of all races and skin colors can get vitiligo, and the disease occurs about equally in people of all races.  About half the people who develop vitiligo get it before they turn 20 years of age. For many of these people, vitiligo begins when they’re a child. Children who develop vitiligo often have a relative with this condition.

Vitiligo is an autoimmune disease. This type of disease develops when your immune system attacks part of your own body.  If you have vitiligo, your immune system attacks cells in your body called melanocytes. These are cells that make pigment.  Depending on where in your body the immune system destroys these pigment-making cells, you will have:

  • Lighter patches and spots on your skin
  • Loss of color inside your mouth or nose, which may spread and cause loss of color on your lips, around your mouth, or outside your nose
  • Hair on your head turn prematurely gray or develop a white streak
  • Part (or all) of an eyebrow or eyelash turn white, or hair covering a patch of vitiligo turn white.
  • Loss of color in part of an eye
  • Hearing loss, as the inner ear contains melanocytes

If the body continues to attack melanocytes, the patches will grow, and new spots and patches can appear in other areas.

Symptoms

The most noticeable sign of vitiligo is one or more areas of lighter skin. For many people, that’s the only sign of vitiligo. However, other signs and symptoms can develop. The following explains what you may notice.

Spots and patches of lighter skin.  When a person has vitiligo, cells that make pigment are damaged. Because these cells give the skin its color, spots and patches of lighter skin appear. Vitiligo can appear anywhere on a person’s skin, including the genitals.

Patches turn white.  When vitiligo is actively destroying cells that give a person’s skin its color, the patches tend to be pink or tricolor (causing a zone of tan skin between a person’s natural skin color and the white vitiligo). Once vitiligo is no longer active, the patches turn completely white, as shown here.

Lighter patches inside your mouth or nose.  Vitiligo can cause loss of color in the mouth, on the lips, around the mouth, around the nose, or inside the nose.

Patches and spots sunburn easily. Skin that’s lost pigment is more sensitive to sunlight, so it sunburns quickly. Sunburns can also trigger vitiligo, causing it to spread. That’s why sun protection is so important.

Patches itch.  When vitiligo is actively spreading, patches may feel itchy. Otherwise, the spots and patches rarely cause discomfort.

Hair turns white or gray.  Vitiligo can cause a person’s hair to lose its color. When vitiligo appears on the skin, the hair in that area can turn white, as shown in picture A. Vitiligo can also cause a person’s hair to turn prematurely gray, as shown in picture B.

Eyelash, eyebrow, or section of hair on the scalp turns white.  Some people develop loss of color on part (or all) of an eyelash or eyebrow. Others see a streak of white hair on their head.

Hearing loss develops.  Melanocytes are the cells that give skin, hair, and eyes their color. The inner ear also contains these cells. When a person has vitiligo, the body attacks melanocytes. If the body attacks melanocytes in the inner ear, a person can have hearing loss. 

Eye color changes.  If vitiligo affects the eyes, your eye color could change. This happens quickly. While rare, vitiligo can also affect a person’s eyesight.

Risk Factors

Inheriting certain genes may increase the risk of something triggering (causing it to happen) vitiligo. Known vitiligo triggers include:

  • A severe sunburn
  • Injured skin (cut, scrape, burn)
  • Getting a strong chemical like phenol on your skin
  • Inheriting certain genes may increase the risk of something triggering (causing it to happen) vitiligo.
  • Known vitiligo triggers include:
  • A severe sunburn
  • Injured skin (cut, scrape, burn)
  • Getting a strong chemical like phenol on your skin

Source: American Academy of Dermatology

When treating vitiligo, board-certified dermatologists create a treatment plan with these goals in mind:

  • Restore lost skin color
  • Stop the patches and spots from getting bigger and new spots from appearing

There is no one best treatment for vitiligo. Before creating a treatment plan, a dermatologist thinks about what is best for each patient. To do this, your dermatologist considers your age, overall health, and effects the disease has on your life. The type of vitiligo, where it appears on the body, and how it’s progressing also play important roles.

If you decide to treat vitiligo, it’s important to know the following:

  • Treatment works slowly. When treatment works, your natural skin color returns a little at a time.
  • Vitiligo can be stubborn. Your dermatologist will begin with the gentlest treatment that’s suitable for you. To get desirable results, your dermatologist may add another treatment or change your treatment.
  • Treatment cannot cure vitiligo. While researchers are looking for a cure, treatment cannot currently cure this disease. Treatment can help restore lost skin color, but results may fade over time. Many patients return for maintenance treatment to keep their results.

Here are the treatments that dermatologists consider for their patients who have vitiligo.

  1. Medication you apply to your skin.  Purpose: Restore lost skin color.

Several prescription medications that you apply to your skin are used to treat vitiligo. You apply these at home.

One of these medications is a prescription corticosteroid. This medication works best for people who recently developed vitiligo.  Due to possible side effects, dermatologists prescribe a corticosteroid for a short period of time. When used short-term, this medication is often effective for both children and adults.

Tacrolimus ointment or pimecrolimus cream is another option for children and adults. One advantage of these medications is that they can be used for a longer time than corticosteroids. These work best to treat skin on the head or neck.

Another medication that may restore lost pigment is calcipotriene. While not effective when used alone, it can be effective when used with a corticosteroid. Applying both of these medications as directed can increase the amount of re-pigmentation you see and shorten the time it takes to get results. Dermatologists prescribe calcipotriene for children and adults.

  1. Light and laser therapy.  Purpose: Restore lost skin color.

Light therapy exposes your skin to a type of ultraviolet (UV) light that can restore your natural skin color. If a large area of your body needs treatment, your dermatologist may prescribe a treatment called phototherapy.  During phototherapy, you expose your skin to UV light for a specific amount of time. A dermatologist calculates the right amount of time for each patient. The UV light comes from a light box, which you stand in. Light therapy is most effective at restoring color to the face and neck. The lips, tips of the fingers, and toes are least responsive to treatment with light therapy.

Light therapy works slowly and does require a number of treatments. To return color to your skin more quickly, your dermatologist may prescribe light therapy along with treatment that you apply to your skin.

If you need treatment targeted to a certain part of your body, your dermatologist may prescribe laser therapy. A laser can target a small section of skin, so there’s less effect on skin that doesn’t need treatment.  

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XTRAC clears the symptoms, prolongs the remission and returns skin to a clinically healthy state in record time. All of which means XTRAC delivers consistently predictable results so patients experience more good days of living than bad.

  • Effective treatment—symptoms reduced generally in 10-12 treatment sessions
  • Long-lasting relief—typically several months free of symptoms"
  • Simple, painless treatment—sessions are very short
  • Relief without messy creams and daily skin care regimen
  • Covered by most major insurance companies, available by Rx
  1. Medication you take.  Purpose: Slow down the development of new spots and patches, restore skin color

Vitiligo tends to spread slowly. Occasionally, it spreads quickly. If you’re seeing new patches and spots on your skin frequently, your dermatologist may prescribe prednisone. This is a powerful medication that can help slow down the disease. It comes in pill form. You take prednisone for one to two weeks.

  1.  Purpose: Restore skin color.

If other treatments fail to restore skin color, surgery may be an option. Two types of surgery are used to treat vitiligo:

  • Skin graft: Your dermatologic surgeon removes some healthy, pigmented skin and transplants it to one or more areas with vitiligo.
  • Cell transplant: During this type of surgery, your dermatologic surgeon removes some healthy, pigmented skin. Instead of grafting the skin into an area with vitiligo, the surgeon takes cells from the skin that was removed. These cells are then placed into skin with vitiligo. Most re-pigmentation from these cells happens within six months of surgery. However, dermatologists have seen patients continue to re-pigment for up to 12 months.

Surgery may be an option for people of all skin tones and for people who have different types of vitiligo. However, it’s not an option for everyone.  Surgery usually isn’t recommended for people who have active vitiligo, which means that over the last 12 months new spots have developed or existing spots have grown.  It also may not be an option for people who developed raised scars because surgery could cause scarring.

  1. Makeup, self-tanner, and skin dye.  Purpose: Even out your skin tone right away.

Getting results from treatment takes time. To help you even out your skin tone until you get results, your dermatologist may recommend using one of these products.

  • Camouflage makeup
  • Self-tanner
  • Skin dyes

These are also an option for patients who decide not to treat vitiligo.  If you’re interested in trying these products, ask your dermatologist for a recommendation. Your dermatologist can recommend a product that will match your skin tone and stay on all day long.  As a rule, self-tanning products are waterproof and give you coverage for 3 to 5 days. Camouflage makeup is lightweight and waterproof, but you need to apply it every day.

To get natural-looking results from these products, you’ll need to learn how to apply them and practice.

  1. Diet and supplements for vitiligo.  Purpose: To provide your body with missing nutrients.

You may have heard that certain vitamins, minerals, amino acids, or enzymes can restore your natural skin color. Researchers are studying the effects that these may have on vitiligo. More research is needed to know whether any diet or supplements can effectively treat vitiligo.

  1.  Purpose: Remove the remaining color from your skin.

Depigmentation is rarely used. It’s only an option for patients who have lost most of their natural skin color and don’t want to continue with treatment meant to restore color to their skin.  Depigmentation removes the remaining natural color, creating an even skin tone. To remove the remaining color from their skin, a patient applies a cream to the areas of skin that still have pigment. The cream gradually removes the remaining color. It can take one to four years to get rid of the remaining pigment.

If you’re considering this approach, talk with a board-certified dermatologist about the pros and cons of depigmentation. This treatment is considered permanent.

How do dermatologists treat vitiligo in children?

Vitiligo can begin at any early age. This makes treatment options for children important.

Many treatments described above are used to treat children. Before creating a treatment plan for your child, your dermatologist thinks about the child’s age, how the vitiligo is spreading, other medical conditions your child has, and many other considerations.

There is currently no way to prevent or cure vitiligo. If you see light-colored spots or patches on your skin, see a board-certified dermatologist. A dermatologist can tell you whether you have vitiligo or another medical condition. There are many other skin diseases that can cause skin lightening, which can be treated.  If you have vitiligo, the sooner vitiligo treatment starts, the more effective it tends to be. Left untreated for years, vitiligo may be difficult to treat.

Dermatologists are studying new vitiligo treatments.  Vitiligo can be stubborn. To find better treatments, dermatologists run clinical trials. Results from recent clinical trials are promising.

Source: American Academy of Dermatology

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