Overview

Vitiligo is a long-term condition where pale white patches develop on the skin. It's caused by the lack of melanin, a pigment in the skin.

Vitiligo can affect any area of skin, but most commonly occurs on the face, neck and hands, and in skin creases.

The pale areas of skin are more vulnerable to sunburn, so it's important to take extra care when in the sun and use a sunscreenwith a high sun protection factor (SPF).

Title
Vitiligo

Types

There are two main types of vitiligo:

  • non-segmental vitiligo
  • segmental vitiligo 
  • In rare cases, it's possible for vitiligo to affect your whole body. This is known as universal or complete vitiligo.
Symptoms

The areas most commonly affected by vitiligo include:

  • the skin around your mouth and eyes
  • fingers and wrists
  • armpits
  • groin
  • genitals
  • inside your mouth

It can also sometimes develop where there are hair roots, such as on your scalp. The lack of melanin in your skin can turn the hair in the affected area white or grey.

Vitiligo often starts as a pale patch of skin that gradually turns completely white. The centre of a patch may be white, with pale skin around it. If there are blood vessels under the skin, the patch may be slightly pink, rather than white.

The edges of the patch may be smooth or irregular. They're sometimes red and inflamed, or there's brownish discolouration (hyperpigmentation).

Vitiligo doesn't cause discomfort to your skin, such as dryness, but the patches may occasionally be itchy.

The condition varies from person to person. Some people only get a few small, white patches, but others get bigger white patches that join up across large areas of their skin.

There's no way of predicting how much skin will be affected. The white patches are usually permanent.

Causes

Vitiligo is caused by the lack of a pigment called melanin in the skin. Melanin is produced by skin cells called melanocytes, and it gives your skin its colour.

In vitiligo, there aren't enough working melanocytes to produce enough melanin in your skin. This causes white patches to develop on your skin or hair. It's not clear exactly why the melanocytes disappear from the affected areas of skin.

Autoimmune conditions

Non-segmental vitiligo (the most common type) is thought to be an autoimmune condition.

In autoimmune conditions, the immune system doesn't work properly. Instead of attacking foreign cells, such as viruses, your immune system attacks your body's healthy cells and tissue.

If you have non-segmental vitiligo, your immune system destroys the melanocyte skin cells that make melanin.

Vitiligo is also associated with other autoimmune conditions, such as hyperthyroidism (an overactive thyroid gland), but not everyone with vitiligo will develop these conditions.

Risk factors

You may be at increased risk of developing non-segmental vitiligo if:

  • other members of your family have it
  • there's a family history of other autoimmune conditions – for example, if one of your parents has pernicious anaemia (an autoimmune condition that affects the stomach)
  • you have another autoimmune condition
  • you have melanoma (a type of skin cancer) or cutaneous T-cell lymphoma (cancer of the lymphatic system)
  • you have particular changes in your genes that are known to be linked to non-segmental vitiligo
  • Neurochemicals

    Segmental vitiligo (the less common type) is thought to be caused by chemicals released from the nerve endings in your skin. These chemicals are poisonous to the melanocyte skin cells.

    Triggers

    It's possible that vitiligo may be triggered by particular events, such as:

  • stressful events, like childbirth
  • skin damage, such as severe sunburn or cuts (this is known as the Koebner response)
  • exposure to certain chemicals – for example, at work
  • Vitiligo isn't caused by an infection and you can't catch it from someone else who has it.
Diagnosis

Your GP will be able to diagnose vitiligo after examining the affected areas of skin.

They may ask whether:

  • there's a history of vitiligo in your family
  • there's a history of other autoimmune conditions in your family
  • you've injured the affected areas of skin – for example, whether you've had sunburn or a severe rash there
  • you tan easily in the sun, or whether you burn
  • any areas of skin have got better without treatment, or whether they're getting worse
  • you've tried any treatments already

Your GP may also ask you about the impact vitiligo has on your life. For example, how much it affects your confidence and self-esteem, and whether it affects your job.

Wood's lamp

If available, your GP may use an ultraviolet (UV) lamp called a Wood's lamp to look at your skin in more detail. You'll need to be in a dark room and the lamp will be held 10 to 13cm (4 to 5in) away from your skin.

The patches of vitiligo will be easier to see under the UV light, which will help your GP distinguish vitiligo from other skin conditions, such as pityriasis versicolor (where there's a loss of pigment due to a fungal infection).

Other autoimmune conditions

As non-segmental vitiligo is closely associated with other autoimmune conditions, you may be assessed to see whether you have any symptoms that could suggest an autoimmune condition, such as:

  • being tired and lacking energy (signs of Addison's disease)
  • being thirsty and needing to urinate frequently (signs
  • of diabetes)

A blood test may also be needed to check how well your thyroid gland is functioning.

Treatment

The white patches caused by vitiligo are usually permanent, although treatment options are available to improve the appearance of your skin.

If the patches are relatively small, skin camouflage cream can be used to cover them up.

In general, combination treatments, such as phototherapy (treatment with light) and medication, give the best results.

Although treatment may help restore colour to your skin, the effect doesn't usually last. Treatment can't stop the condition spreading.

Complications

Vitiligo can sometimes cause other problems.

Because of a lack of melanin, your skin will be more vulnerable to the effects of the sun. Make sure you use a strong sunscreen to avoid sunburn.

Vitiligo may also be associated with problems with your eyes, such as inflammation of the iris (iritis), and a partial loss of hearing (hypoacusis).

Problems with confidence and self-esteem are common in people with vitiligo, particularly if it affects areas of skin that are frequently exposed.