What Is Vitiligo?

Vitiligo is an autoimmune skin condition that causes your skin to lose color and turn into white-colored patches. Researchers estimate that between 0.5% and 2% of the population develop vitiligo. The condition can affect anyone. Vitiligo affects men and women, and people of all races equally. However, patches tend to be more noticeable in people with darker skin tones.

Most commonly, people with vitiligo experience skin-related symptoms. But, the condition can also affect your hair, ears, eyes, and mental health. Vitiligo patches can arise anywhere on the body and tend to grow over time. What your patches look like and where they’re located will depend on the type of vitiligo you have.

Like most autoimmune conditions, researchers don’t know the exact cause of vitiligo. And while there is no cure for vitiligo, a combination of treatments and preventative measures can slow your condition from progressing.  

Types

There are two major types of vitiligo: segmental (patches on one side of the body) and non-segmental vitiligo (patches on both sides of the body). The condition is further broken down into subtypes, which include:  

• Focal: One small, isolated patch of vitiligo which has not spread or gotten bigger for at least one year  
• Mucosal: Affects the mucous membranes (soft tissues that produce mucus) and appears near the mouth and genitals
• Acrofacial: Patches that appear on the limbs and/or face, which tend to occur first on the fingertips and mouth before spreading to other parts 
• Generalized: Appears on any part of your skin, usually in a symmetrical pattern on both sides of the body 
• Universal: Starts as generalized vitiligo, but patches eventually cover 80% to 90% of your skin 
• Unisegmental: Also known as monosegmental vitiligo, patches group together on one side of the body 
• Mixed: Occurs when you have both segmental and nonsegmental types of vitiligo at the same type 

Symptoms 

Vitiligo is a progressive disease that can worsen over time. Most people with vitiligo experience milky white patches on their skin. But, the condition can also affect your hair, ears, and eyes. 

Symptoms can vary depending on the type of vitiligo you have. General symptoms of vitiligo may include: 

• Painless, milky white patches that appear on any part of the skin and can spread over time
• Sensitivity to the sun which can make you prone to sunburn
• Hair that prematurely becomes gray or white in areas where you are developing patches
• Changes in your hearing or experiencing hearing loss, which can affect 12% to 38% of people with vitiligo
• Color changes in your iris, or the colored part of your eyes
• Inflammation of the retina—the light-sensitive layer in your inner eye—which can affect vision in rare cases

Causes 

Before understanding the causes of vitiligo, it’s important to learn how your skin develops pigment.

Here’s a brief overview of skin pigmentation:

• The pigment on your skin comes from a substance called melanin
• Melanin comes from skin cells called melanocytes
• Your genetics determine how much melanin you have 
• The more melanin you have, the darker your, hair, and eyes typically become 

When you have vitiligo, your melanocytes stop functioning properly, which causes you to lose skin pigmentation. Why a dysfunction occurs with your melanocytes is still unknown to researchers. 

But, experts believe that vitiligo is an autoimmune condition that causes your immune system to attack healthy skin cells by mistake. Some evidence suggests that vitiligo can be triggered by oxidative stress—which occurs when your body isn’t able to remove naturally produced toxins. However, research remains ongoing to understand the exact cause of the condition and what can trigger the onset of symptoms.

Risk Factors

While the exact cause of vitiligo is to be determined, some factors can increase your risk of developing the condition. These factors include:

• Having a family history of vitiligo
• Receiving a diagnosis for other autoimmune conditions including Addison’s disease, psoriasis, rheumatoid arthritis, lupus, thyroid disease, and type 1 diabetes 
• Being exposed to environmental triggers such as sunburn, skin injury, or certain toxins and chemicals
• Experiencing emotional or physical stress

Diagnosis 

There is no one specific test that healthcare providers use to diagnose you with vitiligo. But, your provider may use a variety of measures to provide you with an accurate diagnosis and rule out other related conditions. 

These tests include:

• Medical history: Your provider will ask you about your personal and family medical history, what your symptoms look like, when you first began to notice symptoms, which medications you’re taking, and if you’ve been exposed to environmental or lifestyle changes 
• Evaluation: After taking your medical history, your provider will examine your skin patches and check to their pattern, shape, color, and for any signs of inflammation
• Wood’s lamp: In harder-to-diagnose cases, your provider may use an ultraviolet (UV) device called a Wood’s lamp, which can help them look for patches
• Skin biopsy: While a biopsy (a procedure that removes a skin sample) isn’t usually needed, this can help your provider rule out other causes of depigmentation (loss of skin color)
• Blood test: If your provider suspects you may have a co-occurring autoimmune condition with vitiligo, they may take a sample of your blood to test for related conditions 

Treatments

There is no cure for vitiligo, but treatment can help prevent your condition from getting worse. You and your healthcare provider will create a treatment plan that is best for you individually. Options for treatment may include phototherapy, medications, and surgery. 

Phototherapy

Phototherapy—or light therapy—uses ultraviolet (UV) rays to slow the progression of vitiligo. There are several types of light therapy, which include:

• Targeted phototherapy: Typically uses a laser to target smaller vitiligo patches 
• Narrowband ultraviolet B (NBUVB): Uses UVB light rays on larger vitiligo patches 
• Psoralen ultraviolet A (PUVA): Involves a combination of UVA light rays and taking a light-sensitive medication that absorbs UV light, called psoralen 

Depending on the severity of your condition and what your health insurance covers, you can either attend light therapy sessions at your healthcare provider’s office or do light therapy at home. 

Medications  

Your healthcare provider may also prescribe you one or more medications, which may include:

• Glucocorticoids: Oral medications such as Rayos (prednisone) or Decadron (dexamethasone) can slow the spread of vitiligo patches  
• Immunosuppressants: Drugs such as Otrexup (methotrexate) or Sandimmune (cyclosporine) that can help reduce activity in your immune system 
• Topical corticosteroids: Creams you can put directly on your skin, such as Elocon (mometasone furoate) or Dermovate (clobetasol)
• Topical calcineurin inhibitors: Ointments such as Prograf (tacrolimus) and Elidel (pimecrolimus) that you can use for smaller and more delicate areas of your body such as your face or genitals  
• Topical Janus kinase (JAK) inhibitors: In 2022, Opzelura (ruxolitinib) cream became the first FDA-approved JAK inhibitor for vitiligo in people ages 12 and up. JAK inhibitors are commonly used to treat autoimmune conditions such as rheumatoid arthritis.

Surgery

In instances where your body is not responding to other treatments, your healthcare provider may recommend surgery to introduce healthy skin tissue to your body. Typically, your provider will suggest therapies and medication before resorting to surgical options. 

If you do meet the criteria for surgery, your options may include various types of surgical grafts—or, procedures that move tissue from one part of the body to another part of the body.

• Tissue graft: This technique uses pigmented skin from your thigh or butt to transplant it to body parts with vitiligo patches  
• Cellular graft: A procedure that involves transplanting melanocytes to areas with vitiligo patches
• Hair follicle graft: A surgical option that takes hair follicles and places them on vitiligo patches  

Depigmentation 

In rare cases where you have extensive vitiligo—meaning you have patches on the majority of your skin—your provider may suggest depigmentation. This procedure involves using chemical agents to take away your original skin color from areas that don’t have patches to even your skin tone and overall appearance.

It can take three to six months of treatment to see the full effects of depigmentation. Keep in mind: this treatment is not recommended unless you have severe vitiligo. Depigmentation is also not widely available in all areas.    

Prevention

While there’s no way to prevent the onset of vitiligo, being proactive about seeking care and making certain lifestyle changes can keep your condition from worsening. Here are some steps you can take to slow disease progression:

• Limit sun exposure by using SPF 30 (or stronger) sunscreen, wearing full sleeve clothing or layers, and staying in the shade on sunny days
• Taking your medications as they are prescribed
• Choosing anti-inflammatory foods such as leafy green vegetables, yogurt, fatty fish, eggs, berries, and nuts
• Avoiding foods that can cause inflammation such as fried foods, processed meats, white bread or pasta, sugary drinks, and alcoholic beverages

Co-occurring Conditions   

There are several conditions that you’re more likely to develop if you have vitiligo. Nearly one in five people with vitiligo also live with an additional autoimmune condition. The most common conditions that co-occur with vitiligo are:

• Thyroid disorders: Conditions such as hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) 
• Psoriasis: A skin condition that causes discolored and inflamed patches 
• Rheumatoid arthritis: Joint-related condition that causes pain and swelling 
• Alopecia areata: Causes sudden hair loss on the scalp and face 
• Inflammatory bowel disease: Inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease, cause pain and inflammation in your stomach and intestines 
• Type 1 diabetes: A condition that makes it difficult for your body to produce insulin, a hormone that helps turn sugar into energy

Living With Vitiligo  

Vitiligo isn’t a dangerous or fatal condition, but it can significantly affect your quality of life. But, because the condition affects your appearance, many people with vitiligo may feel embarrassment or shame. As a result, you may experience depressive moods, anxious thoughts, and a fear of social situations to avoid stigma.

If you have vitiligo or start experiencing symptoms, it’s important to reach out to your healthcare provider. While there is no cure for vitiligo, getting an early diagnosis and starting treatment can prevent your condition from progressing. Your healthcare provider can help you create a treatment plan that meets your individual needs. They can also refer you to a mental health professional if you’re looking for counseling and emotional support.