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Vitiligo
Autoimmune disorder - vitiligo
Vitiligo is a skin condition in which there is a loss of color (pigment) from areas of skin. This results in uneven white patches that have no pigment, but the skin feels like normal.
Patches
A patch is a flat area of color change in the skin that is 1 cm or more wide.
Causes
Vitiligo seems to occur when immune cells destroy the cells that make brown pigment (melanocytes). This destruction is thought to be due to an autoimmune problem. But, the exact cause of vitiligo is unknown.
Autoimmune
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 types of aut...
Vitiligo may appear at any age. There is an increased rate of the condition in some families.
Vitiligo is associated with other autoimmune diseases:
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Addison disease
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Pernicious anemia
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Symptoms
Flat areas of normal-feeling skin without any pigment appear suddenly or gradually. These areas have a darker border. The edges are well defined, but irregular.
Vitiligo most often affects the face, elbows and knees, back of the hands and feet, and genitals. It affects both sides of the body equally.
Vitiligo is more noticeable in darker-skinned people because of the contrast of white patches against dark skin.
No other skin changes occur.
Exams and Tests
Your health care provider can usually examine your skin to confirm the diagnosis.
Sometimes, the provider may use a Wood light . This is a handheld ultraviolet light that causes the areas of skin with less pigment to glow bright white.
Wood light
A Wood's lamp examination is a test that uses ultraviolet (UV) light to look at the skin closely.
In some cases, a skin biopsy may be needed to rule out other causes of pigment loss. Your provider may also perform blood tests to check the levels of thyroid or other hormones, glucose level, and vitamin B12 .
Skin biopsy
A skin lesion biopsy is when a small amount of skin is removed so it can be examined. The skin is tested to look for skin conditions or diseases. A...
Vitamin B12
Vitamin B12 is a water-soluble vitamin. Water-soluble vitamins dissolve in water. After the body uses these vitamins, leftover amounts leave the bo...
Treatment
Vitiligo is difficult to treat. Early treatment options include the following:
- Phototherapy, a medical procedure in which your skin is carefully exposed to ultraviolet light. Phototherapy may be given alone, or after you take a drug that makes your skin sensitive to light. A dermatologist performs this treatment.
- Certain lasers may help the skin repigment.
- Medicines applied to the skin, such as corticosteroid creams or ointments, immunosuppressant creams or ointments such as pimecrolimus (Elidel) and tacrolimus (Protopic), or topical drugs such as methoxsalen (Oxsoralen) may also help.
Skin may be moved (grafted) from normally pigmented areas and placed onto areas where there is pigment loss.
Several cover-up makeups or skin dyes can mask vitiligo. Ask your provider for the names of these products.
In extreme cases when most of the body is affected, the remaining skin that still has pigment may be depigmented. This is a permanent change that is used as a last option.
It is important to remember that skin without pigment is at greater risk for sun damage. Be sure to apply a broad-spectrum (UVA and UVB), high-SPF sunscreen or sunblock. Sunscreen can also be helpful for making the condition less noticeable, because unaffected skin may not darken in the sun. Use other safeguards against sun exposure, such as wearing a hat with a broad rim and long sleeve shirt and pants.
Support Groups
More information about vitiligo can be found at:
- American Vitiligo Research Foundation: www.avrf.org
- National Vitiligo Foundation: www.nvfi.org
- VitiligoSupport.com: www.vitiligosupport.org
Outlook (Prognosis)
The course of vitiligo varies and is unpredictable. Some areas may regain normal pigment (coloring), but other new areas of pigment loss may appear. Skin that is repigmented may be slightly lighter or darker than the surrounding skin. Pigment loss may get worse over time.
When to Contact a Medical Professional
Call for an appointment with your provider if areas of your skin lose their coloring for no reason (for example, there was no injury to the skin).
References
Habif TP. Light-related diseases and disorders of pigmentation. In: Habif TP, ed. Clinical Dermatology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 19.
Hadi SM, Spencer JM. Vitiligo. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 245.
Patterson JW. Disorders of pigmentation. In: Patterson JW, ed. Weedon's Skin Pathology . 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap 10.
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Vitiligo - illustration
Vitiligo is a condition which involves complete loss of melanin, the primary skin pigment. The cause of vitiligo is unknown but it appears to be an acquired condition and may appear at any age. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face or it may be patchy. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.
Vitiligo
illustration
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Vitiligo, drug induced - illustration
The white spots on this person's face have resulted from drug-induced vitiligo. Loss of melanin, the primary skin pigment, occasionally occurs as a result of medicines, as is the case with this individual. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.
Vitiligo, drug induced
illustration
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Vitiligo on the face - illustration
This is a picture of vitiligo on the face. Complete loss of melanin, the primary skin pigment, occurs for unknown reasons. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face -- symmetrically -- or it may be patchy -- asymmetrical. The typical vitiligo lesion is flat (macular) and depigmented, but maintains the normal skin texture. The dark areas around the eyes are this person's normal skin color.
Vitiligo on the face
illustration
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Vitiligo on the back and arm - illustration
Vitiligo is characterized by patches of depigmented skin. Here, the contrast is seen very clearly. People with very light skin may not notice small areas of vitiligo. This person is receiving ultraviolet light treatment to help normalize the color of the skin.
Vitiligo on the back and arm
illustration
-
Vitiligo - illustration
Vitiligo is a condition which involves complete loss of melanin, the primary skin pigment. The cause of vitiligo is unknown but it appears to be an acquired condition and may appear at any age. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face or it may be patchy. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.
Vitiligo
illustration
-
Vitiligo, drug induced - illustration
The white spots on this person's face have resulted from drug-induced vitiligo. Loss of melanin, the primary skin pigment, occasionally occurs as a result of medicines, as is the case with this individual. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.
Vitiligo, drug induced
illustration
-
Vitiligo on the face - illustration
This is a picture of vitiligo on the face. Complete loss of melanin, the primary skin pigment, occurs for unknown reasons. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face -- symmetrically -- or it may be patchy -- asymmetrical. The typical vitiligo lesion is flat (macular) and depigmented, but maintains the normal skin texture. The dark areas around the eyes are this person's normal skin color.
Vitiligo on the face
illustration
-
Vitiligo on the back and arm - illustration
Vitiligo is characterized by patches of depigmented skin. Here, the contrast is seen very clearly. People with very light skin may not notice small areas of vitiligo. This person is receiving ultraviolet light treatment to help normalize the color of the skin.
Vitiligo on the back and arm
illustration
Review Date: 4/29/2016
Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
