How Is Vitiligo Diagnosed?

Vitiligo is a condition that causes the skin to lose its color, or pigment, in areas around the body.

Researchers believe that vitiligo is an autoimmune disorder, meaning the immune system mistakes healthy cells for harmful ones, attacking the cells in response. In the case of vitiligo, the immune system is attacking the melanocytes. These are the skin cells that produce melanin, the pigment that gives your skin color. Genetic factors and environmental triggers may also play a role in causing vitiligo.

If you have vitiligo symptoms, such as lightened patches in on your skin and premature hair whitening, you may have to see a dermatologist (a medical doctor specializing in skin conditions). They may perform different tests to reach a diagnosis, such as a physical exam, blood test, or biopsy, among others.

Self-Check Exam

First, it is important to perform a self-check skin exam at home to look for any unusual signs or symptoms. There are no home tests that can test for vitiligo, but you can check if you have depigmented areas.

These are the most common symptoms that people with vitiligo develop. Consult a dermatologist if you notice any of the following:

• Lightened patches on the face, arms, and feet
• Light patches on the lips and around the mouth and nose
• Hair turning white or gray
• Itchy skin, especially if accompanied by discoloration of any kind
• Changes in your eye color

It is possible for vitiligo to lead to hearing loss. This is because the inner ear contains melanocytes. Hearing loss can occur when these cells are attacked.

It can also make your skin more sensitive to ultraviolet (UV) rays, increasing your risk of getting sunburn.

You should take note of the areas that have lost their pigment, as this can help your dermatologist determine what type of vitiligo you may have. The three types of vitiligo are:

• Non-segmental vitiligo: This is the most common form of vitiligo. It can affect both sides of your body in any area, but especially the face, neck, genital area, and hands.
• Segmental vitiligo: This develops on only one side (left or right) or part of your body, such as the face or hands. The patches generally appear smaller in size.
• Mucosal: This type affects the mucous membranes in your mouth, nose, and/or genitals.

Physical Exam and Medical History Assessment

To assess you for vitiligo, your healthcare provider will perform a physical exam and ask about your medical history and symptoms. Make sure to let them know if you have a family history of vitiligo or another autoimmune disease, such as diabetes. One-fifth of people with vitiligo also have a close relative with vitiligo.

Your healthcare provider may also ask if you’ve developed any skin rashes recently or tried treating the affected areas at home. It's important to disclose any medications or creams you've used at home, as this may affect the treatments they prescribe to you.

Blood Tests

If you’re diagnosed with vitiligo, your healthcare provider may recommend a blood test. It helps them check if it’s possible that you may have another autoimmune disorder, such as thyroid disease.

Thyroid disease includes one of the following:

• Hypothyroidism: This is when your thyroid gland does not produce enough thyroid hormones. Symptoms include fatigue, sensitivity to cold, constipation, dry skin, and weight gain.
• Hyperthyroidism: This is when your thyroid gland makes more thyroid hormones than what the body needs. Symptoms include weight loss, sweating, rapid or irregular heartbeat, and mood changes.

Blood tests, such as a thyroid function test, can indicate whether you have low or high levels of thyroid-stimulating hormones (TSH) in your blood.

Biopsy

If the dermatologist needs to know more about your skin cells, they may perform a skin biopsy. During this procedure, they take a sample of your skin and examine it under a microscope.

They can confirm that you have vitiligo if the sample does not have pigment-producing cells.

Eye Exam

Many patients with vitiligo have depigmentation on their eyelids. They may also have white hairs in their eyebrow and eyelash area.

Some people with vitiligo develop vision problems, but this is a rare occurrence.  You may have to see an ophthalmologist to check if you have uveitis, or inflammation in your eyes. According to a 2019 study, this affects about 4.8–19% of individuals diagnosed with vitiligo. It can be beneficial to attend regular eye exams—especially if you have vitiligo patches on your head and neck.

Hearing Exam

A 2016 study published in the Autoimmunity Reviews journal found that sensorineural hearing loss is a common symptom among patients with vitiligo. This develops when there is damage to the inner ear or auditory nerve.

An audiologist (a healthcare provider who assesses and treats hearing and balance issues) can assess your hearing if you have hearing problems. This happens when the immune system attacks the pigment cells inside your ear.

Screening for Related Conditions

There are other skin conditions that can cause white patches. Dermatologists use different tests to distinguish the symptoms between vitiligo and other disorders. The conditions that produce similar skin symptoms to vitiligo include tinea versicolor, albinism, pityriasis alba, and idiopathic guttate hypomelanosis.

Tinea Versicolor

This is produced by a fungal infection. Apart from discoloration, it can also cause skin dryness and flakiness. The affected skin areas look yellow under the Wood’s lamp, while vitiligo appears bright blue.

Albinism

Albinism is a genetic condition that is associated with skin discoloration that can also affect a person’s eyesight. People with albinism usually have very pale skin and light blonde hair. It is usually diagnosed at birth, as doctors check if the baby has any discolored areas on their skin, hair, and in their eyes. It is generally apparent at birth.

Albinism can cause vision problems, such as misaligned eyes, light sensitivity, or uncontrollable rapid eye movement. An eye exam may also be helpful to examine the baby’s eye health and look for any concerning signs indicating that they may have albinism.

Genetic testing may also be recommended if you have a family history of albinism, and it indicates the type of albinism you have.

Pityriasis Alba

Pityriasis alba is a type of skin disorder that is known to cause round or oval hypopigmented (light-colored) lesions. It affects mostly children and adolescents.

To reach a diagnosis, dermatologists may perform a Wood lamp exam. Under the lamp, there is no color change in the hypopigmented areas.

Idiopathic Guttate Hypomelanosis

This condition is associated with small, flat areas of white depigmented skin, as there is a decrease in melanin pigmentation. It mostly occurs on areas that have had a lot of sun exposure, such as the shoulders. It is common in older adults who have fair skin.

A skin biopsy helps dermatologists reach a diagnosis, as they can check if there is decreased melanin in the cells.

A Quick Review

Vitiligo is a condition that causes lightened patches on the skin and hair discoloration. Dermatologists use different tests to determine if you have vitiligo or another condition that produces similar symptoms. Some of these tests include blood tests and a skin biopsy.

If you develop vision or hearing problems, an ophthalmologist and audiologist may perform additional tests to assess if vitiligo is affecting these organs.