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.
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:
It is likely that a genetic defect makes the cells more vulnerable to damage.
Vitiligo is more common in people between the ages of 10 and 30 years. Other factors that may increase your chance for vitiligo include:
The main symptom is white patches on the skin. These patches may be clumped together or all over the body. Some common sites of pigment loss include:
White or prematurely graying hair and hair loss may also occur.
Vitiligo often begins with a rapid loss of skin color. This is followed by a long period without any change. Cycles of pigment loss and stability may occur again later. The cycle can continue throughout life.
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.
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:
This may be done by:
PUVA used to be the most common type of repigmentation. Now it is being largely replaced by narrow band UVB (nbUVB). A psoralen cream is applied or a psoralen medication is taken orally. Your body is exposed to UV light A (UV-A) from the sun or an artificial source. The medication is activated by UV-A. It may repigment white patches. This treatment takes months and can cause sunburn-type reactions. It may also cause nausea and an increased risk of skin cancer .
This is a special UV laser. It is shown to be effective in localized cases.
Skin creams may be used to treat the affected areas:
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This involves removing the remaining pigment from your normal skin. This treatment makes your whole body the same white color. It is only done if you have already lost a large amount of your normal skin color and repigmentation has not been successful. The medication used is called monobenzyl ether of hydroquinone 20%. This treatment takes about 1 year to complete. It can cause side effects, such as redness and swelling of your skin.
You can make your white patches less noticeable. Makeup, dyes, stains, or self-tanning lotions can work as a cover. However, the color from dyes, stains, and lotions slowly wears off.
The purpose of sunscreen is to:
Depigmented areas are at much higher risk for skin cancer.
For some, vitiligo can cause social distress, affecting quality of life. Cognitive-behavioral therapy can be used to:
American Academy of Dermatology
National Vitiligo Foundation, Inc.
Canadian Dermatology Association
Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Whitton ME, Watts MJ, Anstey AV, Ingham J, Young K; Therapy Guidelines and Audit Subcommittee, British Association of Dermatologists; Clinical Standards Department, Royal College of Physicians of London; Cochrane Skin Group; Vitiligo Society. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008 Nov;159(5):1051-1076.
Kanwar AJ, Dogra S, Parsad D, Kumar B. Narrow-band UVB for the treatment of vitiligo: an emerging effective and well-tolerated therapy. Int J Dermatol. 2005;44:57-60.
Nicolaidou E, Antoniou C, Stratigos A, Katsambas AD. Narrowband ultraviolet B phototherapy and 308-nm excimer laser in the treatment of vitiligo: A review. J Am Acad Dermatol. 2009;60(3):470-477.
Shah R, Hunt J, et al. Starting to develop self-help for social anxiety associated with vitiligo: using clinical significance to measure the potential effectiveness of enhanced psychological self-help. Br J Dermatol. 2014;171(2):332-337.
Taïeb A, Picardo M. Clinical practice. Vitiligo. N Engl J Med. 2009;360(2):160-169.
Vitiligo. American Academy of Dermatology website. Available at: http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/u---w/vitiligo. Accessed June 8, 2015.
Vitiligo. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 28, 2015. Accessed June 8, 2015.
Vitiligo. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Vitiligo/default.asp. Updated June 2014. Accessed June 8, 2015.
Vitiligo basics. National Vitiligo Foundation website. Available at: http://www.mynvfi.org/about_vitiligo. Accessed August 27, 2014.
Last reviewed June 2015 by Fabienne Daguilh, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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