Vitiligo

The white skin patches of vitiligo can affect how you look and feel about yourself. At Atrium Health Floyd and Harbin Clinic, our dermatologists offer advanced skin care. They work with you to find treatments that can help even out your skin tone and improve your quality of life.

What is vitiligo?

Vitiligo is an autoimmune disease that affects the natural color (pigmentation) of your skin. Loss of pigment causes white patches that can appear anywhere on your body. People of all ages develop vitiligo, but it often starts in the teens and 20s.

Causes of vitiligo

Your skin gets its color from cells called melanocytes. Experts think vitiligo happens when your immune system attacks these cells, causing your skin to lose pigmentation and turn white. Exactly why this happens is unknown.

Vitiligo symptoms

The main symptom of vitiligo is white spots or patches, especially on the hands, arms, face and feet. Pigmentation loss can also occur around body openings, such as the eyes and mouth, or in the mucous membranes of the mouth, nose and genitals.

White patches are more noticeable if you have dark skin. They may stay the same over time or increase in number and size.

People with vitiligo may feel self-conscious about their appearance and experience anger, anxiety or depression. Other symptoms include:

• Premature graying of hair, eyelashes or eyebrows
• Loss of eye color, which can affect eyesight
• Hearing loss from damage to melanocytes in the inner ear

Vitiligo types

Doctors describe vitiligo based on the pattern and extent of the patches. There are two main patterns:

• Nonsegmental: White patches develop on both sides of your body in a symmetrical pattern, such as on both hands or both sides of the face. This form is the most common.
• Segmental: Pigmentation loss occurs in one area of your body, such as on one leg or one side of the face. This type often starts at a young age, progresses quickly and then stabilizes.

In terms of extent, there are several subtypes:

• Focal (localized): A few spots or small patches appear on one or a few body parts and don’t spread over time.
• Generalized: This type appears as widespread scattered patches on various parts of the body.
• Mucosal: This type affects mucous membranes in the mouth, genitals or both.
• Universal: In this rare form, pigmentation loss occurs over most of the body.

Vitiligo diagnosis

Diagnosis is usually based on a review of your medical and family history and a physical examination. Your doctor may use a handheld ultraviolet light to look at your skin. Areas of skin with less pigment glow bright under this light.

In some cases, your doctor may remove a small area of skin for laboratory analysis (skin biopsy). This test can help rule out other causes of pigment loss. You may also need blood tests to check for signs of other autoimmune diseases.

Vitiligo risk factors

You’re more likely to develop vitiligo if you have one or more family members with the condition. Up to one quarter of people with vitiligo also have another autoimmune disease, such as:

• Addison’s disease
• Autoimmune thyroid disease
• Crohn’s disease
• Pernicious anemia
• Psoriasis
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Type 1 diabetes

Vitiligo treatment

Treatment is not a cure, but it can slow disease progression and even out skin tone. Your doctor will recommend treatment based on your condition and needs. Your options may include:

• Topical medications you apply to your skin. These creams or ointments contain corticosteroids or immunosuppressants that help restore skin color over time. A new type of medication, called a Janus kinase (JAK) inhibitor, offers promising results for people with vitiligo. JAK inhibitors work by targeting certain pathways in the immune system.
• Phototherapy, which uses ultraviolet light or lasers to promote repigmentation. Results often take many months and may not be complete.
• Depigmentation to remove pigment from dark skin to match or blend with the white patches.
• Surgery to replace white patches with healthy skin from another area of your body (skin graft).

For people with vitiligo, sun protection is essential. The white patches of skin burn easily. Sun exposure can also darken the skin around the white patches, making them more noticeable. Use a high-SPF sunscreen or wear clothing to protect your skin.

Related conditions

Crohn’s disease

Graves’ disease

Rheumatoid arthritis

Tinea versicolor

Type 1 diabetes