Vitiligo

Vitiligo: This skin disease often forms on both sides of the body as shown here on the knees.

VITILIGO: OVERVIEW

What is vitiligo?
Vitiligo (vit-uh-lie-go) causes the skin to lose its natural color. Patches of lighter skin appear. Some people develop a few patches. Others lose much more skin color.

Vitiligo can also affect other parts of your body. A section of hair can turn white. Some people lose color inside their mouths. Even an eye can lose some of its color.

What causes this color loss is still a mystery. We do know that vitiligo is not contagious. It is not life-threatening.

But vitiligo can be life-altering. Some people develop low self-esteem. They may no longer want to hang out with friends. They can develop serious depression. Most people have vitiligo for life, so it’s important to develop coping strategies.

A coping strategy that helps many people is to learn about vitiligo. Another helpful strategy is to connect with others who have vitiligo.

Vitiligo: It is common to have vitiligo on the hands.

VITILIGO: SIGNS AND SYMPTOMS

Vitiligo causes loss of your natural color. Your dermatologist may call this “loss of pigment” or “depigmentation.” We can lose pigment anywhere on our bodies, including our:

• Skin
• Hair (scalp, eyebrow, eyelash, beard)
• Eyes
• Mouth (inside)
• Genitals

Most people who get vitiligo lose color on their skin. The affected skin can lighten or turn completely white. Many people do not have any other signs or symptoms. They feel completely healthy.

Vitiligo can progress: With time, some people see their vitiligo cover a large area.

A few people say that the skin affected by vitiligo itches or feels painful.

Living with vitiligo can cause other symptoms, such as low self-esteem and depression that is hard to beat. This can happen regardless of the amount of color loss or type of vitiligo.

Vitiligo types and subtypes

If you are diagnosed with vitiligo, your dermatologist may tell you what type and subtype you have.

Types: Today, most doctors recognize two types of vitiligo:

Types of vitiligo: The child on the left has the most common type, non-segmental vitiligo. The child on the right has segmental vitiligo.

Subtypes: The subtype tells you how much vitiligo appears on the body. The vitiligo subtypes are:

• • Localized: One or a few spots or patches appear, but these are limited to one or a few areas of the body.

• • Generalized: Most people develop this subtype, which causes scattered patches on the body.
  • Universal: Most pigment is gone. This is rare.

There is no way to predict how much color a person will lose. Color loss can remain unchanged for years. Some people see patches enlarge and new patches appear. On a rare occasion, the skin may regain its lost color without treatment.

Who gets vitiligo?

Millions of people worldwide have vitiligo. Nearly half get it before they reach 21 years of age. Most will have vitiligo for the rest of their lives. It is very rare for vitiligo to disappear.

Vitiligo occurs about equally in people of all skin colors and races. About half the people who get vitiligo are male and half are female.

The risk of getting vitiligo increases if a person has:

• A close blood relative who has vitiligo.
• An autoimmune disease, especially Hashimoto’s disease (a thyroid disease) or alopecia areata (causes hair loss).

What causes vitiligo?

Vitiligo develops when cells called melanocytes (meh-lan-o-sites) die. These cells give our skin and hair color.

Scientists do not completely understand why these cells die. One type of vitiligo, non-segmental vitiligo, may be an autoimmune disease. An autoimmune disease develops when the body mistakes a part of itself as foreign. If the body mistakes melanocytes as foreigners, it will attack and kill these cells.

Studies suggest that the other type of vitiligo, segmental vitiligo, has a different cause. This type seems to develop when something in the body’s nervous system goes awry.

How do dermatologists diagnose vitiligo?

If your dermatologist suspects that you have vitiligo, your dermatologist will:

• Review your medical history, and may ask specific questions, such as whether anyone in your family has vitiligo.
• Perform a physical exam, looking carefully at the affected skin.

You also may need a blood test to check the health of your thyroid gland. People who have vitiligo often have thyroid disease. A blood test will tell whether your thyroid is healthy. If you have thyroid disease, treatment can successfully control it.

How do dermatologists treat vitiligo?

If you have vitiligo and want to treat it, you should discuss treatment options with a dermatologist. There are many treatment options. The goal of most treatments is to restore lost skin color.

Here are some key facts about treatment options to help you start a conversation with a dermatologist. The type of treatment that is best for you will depend on your preference, overall health, age, and where the vitiligo appears on your body. Some people choose not to treat vitiligo.

1. No medical treatment (use cosmetics to camouflage lost color)

• Cosmetic options include makeup, self-tanners, and skin dyes.
• Offers safe way to make vitiligo less noticeable.
• Often recommended for children because it avoids possible side effects from medicine.
• Drawbacks: Must be repeatedly applied, can be time-consuming, takes practice to get a natural-looking result.

2. Medicine applied to the skin

• Several different topical (applied to the skin) medicines can add color to your skin.
• Prescribed for small areas.
• The most commonly prescribed medicine is a potent or super-potent corticosteroid that you apply to your skin. About half, 45%, of patients regain at least some skin color after 4 to 6 months.
• A corticosteroid that you apply to your skin may be combined with another medicine to improve results.
• This option works best in people with darkly pigmented skin.
• These medicines are most effective on certain areas of the body, such as the face. They are least effective on the hands and feet.
• Some of these medicines should not be used on the face because of possible side effects.
• Drawbacks: These medicines have possible side effects, so patients must be carefully monitored. A possible serious side effect of using of a topical corticosteroid for a year or longer is skin atrophy. This means the skin becomes paper thin, very dry, and fragile.

3. Light treatment

• Uses light to restore lost color to the skin.
• Patient may sit in a light box or receive excimer laser treatments.
• Light boxes are used to treat widespread vitiligo; lasers are used to treat a small area.
• Works best on the face; least effective on hands and feet.
• Effective for many patients; about 70% see results with an excimer laser.
• Results can disappear. About half, 44%, see results disappear within 1 year of stopping treatment. After 4 years, about 86% lose some color restored by treatment.
• May cause patients with darkly pigmented skin to see areas of darker skin after treatment, but treated skin usually matches untreated skin within a few months.
• Requires a time commitment. Patients need 2 to 3 treatments per week for several weeks.
• May be combined with another treatment such as a corticosteroid that you apply to your skin.

4. PUVA light therapy

• Uses UVA light and a medicine called psoralen to restore skin color.
• Psoralen may be applied to the skin or taken as a pill.
• Can treat widespread vitiligo.
• About 50% to 75% effective in restoring pigment to the face, trunk, upper arms, and upper legs.
• Not very effective for the hands or feet.
• Time-consuming, requiring treatment at a hospital or PUVA center twice a week for about 1 year.
• Psoralen can affect the eyes, so this treatment requires an eye exam before and after finishing treatment.
• To help prevent serious side effects, patients are carefully monitored.

5. Surgery

• May be an option when light therapy and medicines applied to the skin do not work.
• For adults whose vitiligo has been stable (not changed) for at least 6 months.
• Not for children.
• Not for people who scar easily or develop keloids (scars that rise above the skin).
• Different surgical procedures are available. Most involve removing skin with your natural color or skin cells and placing these where you need color.
• Can be effective for 90% to 95% of patients.
• Possible side effects include failure to work, cobblestone-like skin, and infection.

6. Unconventional treatment

• Some vitamins, minerals, amino acids, and enzymes have been reported to restore skin color in people who have vitiligo.
• Most have not been studied, so there is no evidence to support these treatments and no knowledge of possible side effects.
• Ginkgo biloba, an herb, has been studied in a clinical trial. Results from this trial indicate that the herb may restore skin color and stop vitiligo from worsening.
• In the ginkgo biloba trial, 10 patients given ginkgo biloba had noticeable or complete return of skin color. Two patients taking the placebo (contains no active ingredient) also had noticeable or complete return of skin color.
• Because some patients taking the placebo regained their skin color, more study is needed.

7. Depigmentation

• This treatment removes the remaining pigment from the skin.
• Very few patients opt for this treatment.
• Removing the rest of the pigment leaves a person with completely white skin.
• It may be an option for an adult who has little pigment left and other treatment has not worked. Removing the remaining pigment can be an effective way to even out the skin color, giving the person white skin.
• To remove the remaining color, you’d apply a cream once or twice a day. This cream gradually removes the remaining color from your skin.
• Depigmentation can take 1 to 4 years.
• Once treatment is finished, some people see spots of pigment on their skin from being out in the sun. To get rid of these spots, you can use the cream to remove this color.

Outcome

It is not possible to predict how a patient will respond to treatment. It is important to keep in mind that no one treatment works for everyone. Results can vary from one part of the body to another. Combining two or more treatments often gives the best results.

Treatment Q&A

Q: Can a child with vitiligo be treated?
A: Yes, but some treatments are not appropriate for children. The following may be an option for a child:

• Medicine applied to the skin.
• PUVA that uses psoralen applied to the skin. PUVA therapy that uses the psoralen pill is usually not recommended until after 12 years of age. Even then, the risk and benefits of this treatment must be carefully weighed.
• For children with extensive vitiligo, a dermatologist may recommend narrowband UVB light treatments.

Q: Are researchers looking for more effective treatment?
A: Yes. They are studying the genes involved in vitiligo. Researchers believe that by identifying all of the genes involved in vitiligo, they will learn what destroys the cells that give skin its color. With this knowledge, it should be possible to develop better treatments. One of the key goals of this research is to develop a treatment that will permanently stop the skin from losing color.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.