Vitiligo

What is vitiligo?

In vitiligo, patches of skin lose their usual colour and turn pale, white or pale pink. Any area can be involved, including the hair, lips, mouth lining and genital skin. Some people have only a few small patches, while others have widespread loss of colour.

Who gets it?

Vitiligo affects about 1 in 100 people worldwide. It can start at any age, but it usually begins before the age of 20. Men and women of every skin tone are equally affected, though the patches tend to stand out more on brown and black skin.

What causes it?

Vitiligo is an autoimmune condition. In vitiligo, the immune system wrongly targets melanocytes. Melanocytes make melanin, which gives skin its colour and offers some protection against the sun. When these cells are damaged, pale or white patches develop.

In some people, new patches appear at sites of skin injury, such as cuts, burns, scratches or areas of friction from tight clothing. This is called the Koebner phenomenon. Stress and sunburn may also be associated with new patches in some people. There is no proven link with diet or smoking.

Is it hereditary or contagious?

There is sometimes a family pattern, but a parent with vitiligo will not necessarily pass it on to their children. It is not contagious and cannot be passed on by touch.

What does it look and feel like?

Vitiligo causes pale, white or pink patches with well-defined edges. The skin feels normal to touch and is not usually itchy or sore, though some people notice itch before a new patch appears. Common areas include the face, especially around the eyes, nose and mouth, the backs of the hands and fingers, the wrists, elbows, knees, armpits, groin and genitals. Hair within a patch may turn white, including eyelashes, eyebrows and beard hair.

Because the patches have no melanin, they burn easily in the sun. When colour returns, it often starts as small dots around hair follicles, giving a speckled appearance.

Associated conditions

People with vitiligo have a higher chance of other autoimmune conditions, particularly thyroid disease, and also type 1 diabetes, pernicious anaemia, alopecia areata and rheumatoid arthritis.

Types of vitiligo

The commonest form is non-segmental vitiligo. The patches generally affect both sides of the body, often as mirror images, and may slowly enlarge with time.

Segmental vitiligo affects one area or one side of the body. It tends to start at a younger age, spreads for a period of months to a couple of years, and then usually stabilises.

Knowing which type you have helps predict how it may behave and which approach is likely to help.

The emotional impact

Vitiligo affects people very differently. Some people are untroubled by it, whereas others find it very distressing, with an effect on confidence and sometimes anxiety or low mood. The visibility of patches can be particularly difficult for people with brown or black skin. These feelings are important and worth discussing.

How is it diagnosed?

Vitiligo is usually diagnosed from its appearance. An ultraviolet light known as a Wood's lamp helps show up patches, especially on lighter skin. Blood tests may be recommended to check for thyroid disease and other autoimmune conditions. Occasionally, other conditions that cause pale patches need to be ruled out. Photographs are often taken to track changes over time.

What are the treatment options?

Dr Mounsey will confirm the diagnosis, often with a Wood's lamp, and may check for related conditions such as thyroid disease. Treatment can stop or slow spread and encourage colour to return, particularly on the face. Options include potent steroid creams, calcineurin inhibitor creams such as tacrolimus, and ruxolitinib cream, a JAK inhibitor cream licensed for vitiligo on the face and body. Phototherapy may be recommended for more widespread vitiligo. He will also advise on sun protection and camouflage make-up, and on support if vitiligo is affecting your confidence.

What is the outlook?

The course of vitiligo is unpredictable. Patches may stay the same for years, spread, or regain some colour, either on their own or with treatment. There is no cure, but there are options that can help restore colour, particularly on the face, and help slow spread.

More information

British Association of Dermatologists patient leaflet: https://www.bad.org.uk/pils/vitiligo

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.