Definition

Vitiligo is a disorder in which white patches develop on the skin. The patches may appear on any part of the body, including the hair, eyes, and mouth.

Causes

The white patches are due to the destruction of melanocytes cells. These cells in the skin make pigment. Loss of pigment causes the skin to become lighter. It looks especially lighter compared to normal skin nearby. This is why vitiligo is more visible in darker-skinned people.

The exact cause of the pigment loss is not known. Possible causes include:

• The body’s immune system may destroy the melanocytes (autoimmune)
• Melanocytes may destroy themselves
• Defective nerve cells may make toxic substances that harm the melanocytes

It is likely that a genetic defect makes the cells more vulnerable to damage.

Risk Factors

Vitiligo is more common in people between the ages of 10 and 30 years. Other factors that may increase your chance for vitiligo include:

• Family members with vitiligo or hair turning gray early
• Certain autoimmune diseases, such as those that affect the thyroid gland

Symptoms

The main symptom is white patches on the skin. These patches may be any size or location.

• The patches may be focal (only a few areas) or be more widely spread (generalized)
• Patterns include:
  • Nonsegmental (most common):
    • Present on both sides of the body
    • More likely to be generalized and spread
    • May involve the hair
    • Usually autoimmune, with flare-ups
  • Segmental:
    • Present on one side of the body
    • May develop quickly, but then stop spreading
    • Not usually autoimmune

Some common sites of pigment loss include:

• Areas exposed to the sun such as the face, hands, arms, and upper part of the chest
• Areas around body openings such as the eyes, nostrils, mouth, navel, and genitals
• Areas where clothing or jewerly rub, such as the neck
• Body folds such as the groin and armpits
• Sites of chronic minor injury such as knuckles and elbows
• Sites of injury such as scrapes, cuts, and burns
• The area around moles

White or prematurely graying hair and hair loss may also occur.

Cycles of pigment loss and stability may occur, most common with nonsegmental type. The cycle can continue throughout life.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam and eye exam will be done. The diagnosis is usually made by the appearance of the skin. A skin biopsy may be done to confirm it. Special UV lamps may be used during the skin exam.

You may also be tested for other autoimmune diseases, such as hyperthyroidism

Treatment

There is no known cure for vitiligo. Often, the longer the patches exist, the harder it is to repigment the area. Treatment is geared to decreasing the appearance of patches by:

• Repigmentation—replace skin color in patches
• Slowing loss of color
• Decreasing the difference between affected and unaffected skin

This may be done by:

Skin Creams

Skin creams may be used to treat the affected areas:

• Corticosteroid skin cream—Can sometimes slow the loss of color. It may also help return color to small areas. It may cause thinning of the skin.
• Tacrolimus or pimecrolimus skin creams—Can sometimes slow the loss of color. They can help return color to small areas. They may also cause thinning of the skin.
• Skin grafting —Done if the condition is not widespread and stable. It may be possible to graft areas of normal pigmentation to the patches.

Skin Graft

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Prevention

There are no current guidelines to prevent vitiligo.