Understanding Vitiligo

Vitiligo is a skin disorder. This condition causes the skin to lose its natural color (pigmentation). People with vitiligo have light-colored patches on their skin. These patches may be in one small area. Or they may be spread all over the body. Vitiligo is not contagious, so it doesn't spread from person to person. Vitiligo is a lifelong condition that can affect someone’s self-esteem and quality of life.

How vitiligo happens

Your skin color is determined by a pigment made by certain cells in your skin. This pigment is called melanin. Vitiligo occurs because the skin has lost melanin. Experts don’t know what causes this. It may be an autoimmune disorder. This happens when the body’s disease-fighting system (the immune system) attacks the cells that make melanin.

This condition often runs in families. But in some cases, it can just suddenly occur. It often appears before age 20.

Vitiligo can affect people of any race. But it's easier to see it when a person has dark skin.

You may be at higher risk for vitiligo if you have certain autoimmune diseases. It has been linked to thyroid diseases, such as overactive thyroid (hyperthyroidism) and underactive thyroid (hypothyroidism). You may also be more likely to have vitiligo if you have diabetes, Addison disease, rheumatoid arthritis, lupus, or pernicious anemia.

Symptoms of vitiligo

Some people may have just 1 or 2 patches of vitiligo. Others may have it over large parts of their body. Over time, these white areas often get larger.

Vitiligo can appear in any area. In some cases, a section of hair can become white, or an eye may even lose some of its color. The white patches are most often seen on these parts of the body:

• Face

• Fingers, hands, wrists, and elbows

• Toes, ankles, shins, and knees

• Bellybutton

• Nipples

• Anus and genital area

Diagnosing vitiligo

A healthcare provider can often diagnose vitiligo just by looking at it. The provider will do a full body skin exam to see how widespread the condition is. They will also take a full health history. You may have a blood test to check if your thyroid is healthy.

The provider may also shine a black light (UV or ultraviolet light) on your skin in a dark room. The UV light highlights the skin’s coloring. Any abnormal areas, such as those with vitiligo, are easy to see.

Treatment for vitiligo

There is no cure for vitiligo. But treatments may stop the condition from getting worse. A combination of treatments often works best. Treatments can include:

• Nonmedical treatments. Cosmetics and self-tanning creams may help cover up the white patches. They are safe for children to use. But they must be applied often.

• Medicated creams. Different types of creams may be used, but corticosteroids are used most often. Corticosteroid creams help to darken the affected areas. They are often used in cases where the affected skin is limited. But they can take a few months to work. These creams may also have side effects, such as thinning the skin.

• Phototherapy and psoralens. You may still have some skin cells that make melanin in your vitiligo patches. If so, being exposed to UV light in a healthcare provider’s office (phototherapy) can help trigger pigment production. Medicines that make the skin more sensitive to light (psoralens) may also be used. These are used most often to treat widespread vitiligo.

• Surgery. This may be a choice for some adults when skin doesn't respond to phototherapy and medicines. Different types of surgery may be done. Most methods will transplant skin with your natural color or skin cells, into affected areas. Tattooing is another choice. This uses a special surgical tool to add pigment to your skin. It works best in areas such as the lips, nipples, and fingertips.

• Bleaching (depigmentation). This treatment is not often used. A cream is used to remove the remaining color from the unaffected skin. The person is then left with white skin everywhere, so the light patches of vitiligo no longer stand out.

Alternative treatments

You may hear about some alternative treatments and wonder if they are right for you. These include some vitamins, herbs, and certain kinds of light therapies. Talk with your healthcare provider first before trying any of these. Some treatments are not proven to be effective and may have significant side effects.

Living with vitiligo

Adults or children with vitiligo should be sure to do the following:

• Protect your skin. The affected, light-colored areas are at risk for severe sunburn. Use sunscreen with an SPF of 30 or higher every day. You should also wear protective clothing to prevent sun exposure.

• Don't get tattoos. Don’t get a tattoo that's not related to your treatment. This may end up causing the white patches to spread.

• Get emotional help. Vitiligo changes the way you look. And this can change the way you feel about yourself. You may feel sad or depressed about your appearance. You may have low self-esteem. You may not feel comfortable being out in public. Both children and adults should get the help they need to cope with this condition. Talk with your healthcare provider about seeing a therapist. And look online to find support groups.