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Vitiligo

By

Shinjita Das

, MD, Harvard Medical School

Last full review/revision Jan 2021| Content last modified Jan 2021
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Topic Resources

Vitiligo is a loss of melanocytes that causes patches of skin to turn white.

  • Patches of whitened skin are present on various parts of the body.

  • Doctors usually base the diagnosis on the appearance of the skin.

  • Corticosteroid creams, other drugs, or phototherapy plus light-sensitizing drugs may help repigment the skin, or, if needed, skin grafts may be used.

Vitiligo affects up to 2% of people.

The cause of vitiligo is unknown, but it is a disorder of skin pigmentation Overview of Skin Pigment Melanin is the pigment that produces the various shades and colors of human skin, hair, and eyes. Coloration (pigmentation) is determined by the amount of melanin in the skin. Without melanin... read more Overview of Skin Pigment that may involve an attack by the immune system on the cells that produce the skin pigment melanin Overview of Skin Pigment Melanin is the pigment that produces the various shades and colors of human skin, hair, and eyes. Coloration (pigmentation) is determined by the amount of melanin in the skin. Without melanin... read more Overview of Skin Pigment (melanocytes). Vitiligo tends to run in families, or people may spontaneously develop it. Vitiligo may occur with certain other diseases. Vitiligo is associated with autoimmune disorders Autoimmune Disorders An autoimmune disorder is a malfunction of the body's immune system that causes the body to attack its own tissues. What triggers autoimmune disorders is not known. Symptoms vary depending on... read more (when the body attacks its own tissues), and thyroid disease is the most common one. It is most strongly associated with an overactive thyroid (hyperthyroidism Hyperthyroidism Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions. Graves disease is the most common cause of hyperthyroidism... read more Hyperthyroidism , particularly when caused by Graves disease) and an underactive thyroid (hypothyroidism Hypothyroidism Hypothyroidism is underactivity of the thyroid gland that leads to inadequate production of thyroid hormones and a slowing of vital body functions. Facial expressions become dull, the voice... read more Hypothyroidism , particularly when caused by Hashimoto thyroiditis Hashimoto Thyroiditis Hashimoto thyroiditis is chronic, autoimmune inflammation of the thyroid. Hashimoto thyroiditis results when the body attacks the cells of the thyroid gland—an autoimmune reaction. At first... read more ). People with diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more , Addison disease Addison Disease In Addison disease, the adrenal glands are underactive, resulting in a deficiency of adrenal hormones. Addison disease may be caused by an autoimmune reaction, cancer, an infection, or some... read more Addison Disease , and pernicious anemia Vitamin B12 Deficiency Vitamin B12 deficiency can occur in vegans who do not take supplements or as a result of an absorption disorder. Anemia develops, causing paleness, weakness, fatigue, and, if severe, shortness... read more also are somewhat more likely to develop vitiligo. However, the relationship between these disorders and vitiligo is unclear.

Occasionally, vitiligo occurs after physical injury to the skin, for example, as a response to a chemical burn or sunburn Sunburn Sunburn results from a brief (acute) overexposure to ultraviolet (UV) light. Overexposure to ultraviolet light causes sunburn. Sunburn causes painful reddened skin and sometimes blisters, fever... read more Sunburn . People may also notice vitiligo is triggered by an episode of emotional stress.

Vitiligo may cause considerable psychologic distress, especially in dark-skinned people.

Symptoms of Vitiligo

In some people, one or two well-defined patches of vitiligo appear. In other people, patches appear over a large part of the body. Rarely, vitiligo occurs over most of the skin surface. The changes are most striking in people with darker skin. Commonly affected areas are the face, fingers and toes, wrists, elbows, knees, hands, shins, ankles, armpits, anus and genital area, navel, and nipples. The affected skin is extremely prone to sunburn. The areas of skin affected by vitiligo also produce white hair because melanocytes are lost from the hair follicles.

Manifestations of Vitiligo

Diagnosis of Vitiligo

  • A doctor's evaluation

Vitiligo is recognized by its typical appearance. A Wood light Wood light (black light) Doctors can identify many skin disorders simply by looking at the skin. A full skin examination includes examination of the scalp, nails, and mucous membranes. Sometimes the doctor uses a hand-held... read more Wood light (black light) examination is often done to help distinguish vitiligo from other causes of lightened skin. Other tests, including skin biopsies, are rarely necessary.

Treatment of Vitiligo

  • Sun protection

  • Cream containing a corticosteroid and calcipotriene or sometimes other substances applied to the skin (topical therapy)

  • Phototherapy and psoralens

  • Surgery

  • Bleaching unaffected skin

Topical therapy

Small patches sometimes darken (repigment) when treated with strong corticosteroid creams. Drugs such as tacrolimus or pimecrolimus may be applied to patches on the face or groin, where strong corticosteroid creams may cause side effects. Calcipotriene (also called calcipotriol), which is a form of vitamin D, blended with betamethasone (a corticosteroid cream), can be effective and is more effective than either cream used alone. Some people simply use bronzers, skin stains, or makeup to darken the area.

Phototherapy and psoralens

Because many people still have a few melanocytes in the patches of vitiligo, exposure to ultraviolet (UV) light in a doctor’s office (phototherapy) restimulates pigment production in more than half of them (see Phototherapy Phototherapy Psoriasis is a chronic, recurring disease that causes one or more raised, red patches that have silvery scales and a distinct border between the patch and normal skin. A problem with the immune... read more Phototherapy ). In particular, psoralens (drugs that make the skin more sensitive to light) combined with UVA light (PUVA) or narrowband UVB light treatment without psoralens can be given. However, phototherapy takes months to years to be effective and may need to be continued indefinitely. It can also lead to skin cancer Overview of Skin Cancer Skin cancer is the most common type of cancer. Skin cancer is most common among people who work or play sports outside and among sunbathers. Fair-skinned people are particularly susceptible... read more . Doctors also use lasers on some people who have small patches that do not respond to corticosteroid creams.

A new class of drugs called Janus kinase inhibitors (or JAK inhibitors) are emerging as possible treatment options for vitiligo. However, depigmentation can recur after use of these drugs is stopped.

Surgery

Areas that do not respond to phototherapy may be treated with various skin-grafting techniques and even transplantation of melanocytes grown from unaffected areas of the person’s skin. Tattooing is especially useful for areas where it is difficult to restimulate pigment production (such as the nipples, lips, and fingertips).

Bleaching

Some people who have very large areas of vitiligo sometimes prefer to bleach the pigment out of the unaffected skin to achieve an even color. Bleaching is done with repeated applications of a strong hydroquinone cream to the skin for weeks to 1 year or more. The cream can be extremely irritating. The effects of bleaching (such as permanent loss of pigment) are irreversible.

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Test your knowledge

Psoriasis
Psoriasis is a common chronic disease affecting 1 to 5% of the population worldwide. It causes distinctive raised, red patches with silvery scales. A border between the patch and normal skin is known as “psoriatic plaque.”  Which of the following is the reason these patches of plaque form?
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