Vitiligo is a condition in which your skin loses melanin, the pigment that determines the color of your skin, hair and eyes. Vitiligo occurs when the cells that produce melanin die or no longer form melanin, causing slowly enlarging white patches of irregular shapes to appear on your skin.
Vitiligo affects all races, but may be more noticeable and disfiguring in people with darker skin. Vitiligo usually starts as small areas of pigment loss that spread with time. These changes in your skin can result in stress and worries about your appearance.
The main sign of vitiligo is:
Pigment loss that produces milky-white patches (depigmentation) on your skin
Other less common signs may include:
Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard
Loss of color in the tissues that line the inside of your mouth (mucous membranes)
Loss of or change in color of the inner layer of your eye (retina)
Although any part of your body may be affected by vitiligo, depigmentation usually develops first on sun-exposed areas of your skin, such as your hands, feet, arms, face and lips. Although it can start at any age, vitiligo often first appears between the ages of 10 and 30. Vitiligo generally appears in one of three patterns:
Focal. Depigmentation is limited to one or a few areas of your body.
Segmental. Loss of skin color occurs on only one side of your body.
Generalized. Pigment loss is widespread across many parts of your body, often symmetrically.
The natural course of vitiligo is difficult to predict. Sometimes the patches stop forming without treatment. But, in most cases, pigment loss spreads and can eventually involve most of the surface of your skin.
When to see a doctor
See your doctor if areas of your skin, hair or eyes lose coloring. Although there's no cure for vitiligo, treatments exist that may help to stop or slow the process of depigmentation and attempt to return some color to your skin.
Vitiligo occurs when melanin — the dark pigment in the epidermis that gives your skin its normal color — is destroyed or not produced. The involved patch of skin then becomes white. Exactly why this occurs isn't known.
Doctors and scientists have theories as to what causes vitiligo. It may be due to an immune system disorder. Heredity may be a factor because there's an increased incidence of vitiligo in some families. Some people have reported a single event, such as sunburn or emotional distress, that triggered the condition. However, none of these theories has been proven as a definite cause of vitiligo.
Medical treatment for vitiligo isn't always necessary. Self-care steps, such as using sunscreen and applying cosmetic camouflage cream, may improve the appearance of your skin. For fair-skinned individuals, avoiding tanning can make the areas almost unnoticeable.
Depending on the number, size and location of the white patches, you may decide to seek medical treatment. Medical treatments for vitiligo aim to even out skin tone, either by restoring color (pigment) or by destroying the remaining color.
Treatment for vitiligo may take as long as six to 18 months, and you may have to try more than one treatment before you find the one that works best for you.
Topical corticosteroid therapy. Corticosteroids may help return color to your skin (repigmentation), particularly if the medication is started early in the disease. Milder topical corticosteroid cream or ointment may be prescribed for children and for people who have large areas of depigmented skin. It may take as long as three months of treatment before you begin to see any changes in your skin's color. This treatment is easy and effective, but your doctor needs to monitor you closely for side effects, such as thinning of the skin (atrophy) and streaks or lines on your skin (skin striae). Calcipotriene (Dovonex), a vitamin D derivative, also may be used topically and is sometimes used with corticosteroids or ultraviolet light.
Topical immunomodulators. Topical ointments containing tacrolimus or pimecrolimus are effective for people with small areas of depigmentations, especially on the face and neck. This treatment may have fewer side effects than corticosteroids and can be used in combination with UVB treatments. However, studies conducted on these treatments have been small, and there is concern that they may be associated with an increased risk of lymphoma and skin cancer.
Oral psoralen photochemotherapy, or PUVA Treatment. If you have depigmented areas that cover more than 20 percent of your body, your doctor may recommend oral psoralen. For this treatment, you take the oral psoralen about two hours before exposure to UVA light. You'll have to visit the doctor two or three times a week, allowing for at least a day in between treatments. As with topical psoralen, the treated skin becomes pink after UVA exposure, and then eventually fades to a more normal skin tone.