Understanding Vitiligo

Other signs and symptoms of vitiligo can include:

• Hair turning prematurely gray or white
• Eyelashes or eyebrows losing color and turning white
• Change of color in the retina of the eye
• Color loss in the nose and mouth
• Inflammation of the ears or eyes, leading to hearing loss and vision problems

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Where skin spots appear, how widespread the condition becomes, and how much it will progress vary from person to person.

There are two major types of vitiligo:

• Nonsegmental Vitiligo The most common type of vitiligo, with pale skin patches usually appearing on both sides of the body. The first signs may show up on hands, fingertips, wrists, around the eyes or mouth, or on the feet. Nonsegmental vitiligo is also called bilateral or generalized vitiligo or vitiligo vulgaris, according to research.

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  Nonsegmental vitiligo is divided into subtypes based on the way the condition shows up. These include acrofacial vitiligo, which appears on the face, hands, and feet; mucosal vitiligo, which affects the mucous membranes of the mouth, nose, and genitals; localized or focal vitiligo, which occurs on just a few areas of the body; and universal vitiligo, which may involve 80 to 90 percent of an affected person’s skin, according to research.

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• Segmental Vitiligo For this type, white patches often appear on just one side of the body, such as one arm or one leg instead of both. Loss of hair color is common. Segmental vitiligo can begin early in life. It may spread rapidly for six months to two years, then stop progressing. In rare cases, this form of vitiligo may become active again years later. About 5 to 16 percent of vitiligo cases are segmental vitiligo.

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You may also have mixed vitiligo, a combination of nonsegmental and segmental vitiligo.

“Vitiligo can have a significant effect on patients,” says Adrienne Haughton, MD, clinical assistant professor of dermatology at Stony Brook Medicine in Commack, New York. “Patients can be very self-conscious and even experience depression.”

These factors are known to increase the risk for vitiligo:

• Family History and Genes About 20 percent of people with vitiligo have at least one close relative affected by this skin disorder, and researchers have found that having a certain genetic profile makes people more susceptible to developing vitiligo. Variations in over 30 genes have been identified that are associated with vitiligo, including two called NLRP1 and PTPN22. These and other genes now linked with vitiligo are known to be involved with immune-system regulation and inflammation.

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• Environmental Triggers Vitiligo seems to be the result of both a preexisting genetic makeup and something in the environment setting off an autoimmune response that destroys melanocytes. Potential triggers include sunburn, exposure to certain chemicals, and trauma or injury to the skin. These triggers can also prompt vitiligo to spread in people who already have the condition.

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• An Existing Autoimmune Disease People with conditions such as Addison’s disease, pernicious anemia, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, thyroid disease, or type 1 diabetes are at an increased risk of developing vitiligo. Fifteen to 25 percent of people with vitiligo have another autoimmune disease.

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If you suspect you may have vitiligo, visit your primary care doctor or a dermatologist. To evaluate a vitiligo diagnosis, your doctor will likely ask about risk factors such as:

• Whether a close relative has been diagnosed with vitiligo
• Whether you have been diagnosed with an autoimmune disorder
• If you’ve experienced recent stress (such as a major life change) or other potentially triggering events (such as a severe sunburn)

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Some dermatologists will want to do more testing beyond a skin exam. Your doctor may order a skin biopsy, which will show whether melanocytes are present in the skin. A lack of melanocytes is an indication of vitiligo. Your doctor may also ask for a blood test to see if you have another autoimmune disease.

Prognosis for Vitiligo

There is not currently a cure for vitiligo, says Michele Green, MD, a dermatologist in private practice in New York City. But a growing variety of treatment options can minimize the appearance of white skin spots.

Nondrug and nonsurgical therapies include:

• Makeup and self-tanners, which can cover up white patches and hair dye to bring color back to graying or white hair
• Light therapy, specifically narrowband UVB, according to Dr. Haughton
• Laser therapy, which is best for targeting small and specific areas of vitiligo

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Medication and Surgery Options for Vitiligo

Other medications may help minimize the appearance of vitiligo. These include:

• Corticosteroid creams, prescribed for the short term
• Ointments containing immunomodulators tacrolimus (Protopic) or pimecrolimus (Elidel), which can be used longer term
• Topical vitamin D analogs (which are synthetic versions of the vitamin)
• Combination therapy with UVA light and the oral medication psoralen, which may be especially effective if you have large areas of skin affected by vitiligo (this form of light therapy is effective but more difficult to administer than UVB)

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• Pigment removal from unaffected skin using monobenzone cream

Some of these treatment options come with negative side effects, such as scarring, dry and itchy skin, and skin with a streaky appearance.

If other treatment options are ineffective, there are two types of surgery available for vitiligo:

• Skin grafts, in which healthy, pigmented skin is transplanted to skin areas affected by vitiligo
• Cell transplants, in which cells from healthy skin are placed into vitiligo-affected skin

Alternative and Complementary Therapies for Vitiligo 

There have also been a few research studies on alternative medicine options, such as treating the area with certain herbs and vitamins. But so far the studies have been too small to draw sweeping conclusions, says Hal Weitzbuch, MD, a dermatologist in private practice in Calabasas, California, and an adjunct professor of medicine at the University of California, Los Angeles School of Medicine. Don’t rely on unproven natural remedies instead of getting the medical care you need for vitiligo, he says.

Prevention of Vitiligo

In general, people who have been diagnosed with vitiligo do not need to be overly worried about developing serious complications.

Vitiligo and Skin Cancer Risk

RELATED: 10 Causes of Skin Cancer

It’s good news for people with vitiligo, but it doesn’t mean they should rely on their condition to give them absolute protection against the effects of the sun. Those with vitiligo simply don’t need to be any more worried about skin cancer than the rest of the population, Dr. Rodrigues says.

Learn More About Vitiligo and Skin Cancer Risk

Vitiligo and Other Autoimmune Disorders

Up to one-quarter of patients with vitiligo have another autoimmune disease. If you have vitiligo, you may be at risk for an autoimmune disorder. So it’s important to discuss any new or unusual health issues you’re experiencing with your primary care practitioner. Vitiligo does not cause other autoimmune conditions, but it may share a genetic basis with one.

Here are some of the most common autoimmune diseases associated with vitiligo:

• Autoimmune thyroid disease
• Rheumatoid arthritis
• Type 1 diabetes
• Psoriasis
• Pernicious anemia
• Addison’s disease
• Systemic lupus erythematosus

Vitiligo and Mental Health Complications

A big concern when it comes to vitiligo complications is the emotional toll of living with a very visible skin condition, especially one that can begin early in life.

“It’s a stigma — people have this aversion because it’s not ‘normal,’” says Sandy Skotnicki, MD, a dermatologist and assistant professor in the department of medicine at the University of Toronto. It can be especially difficult for people with darker skin, Dr. Skotnicki says, because the differences in skin tone are more obvious. For people with light skin, the presence of vitiligo may be less noticeable, Skotnicki adds.

Promising research is underway examining the genetic roots of vitiligo and testing compounds and treatments that may interrupt the autoimmune response, inflammation, and the destruction of melanocytes. Areas of current vitiligo research include:

• Medication that promotes the growth of melanocytes
• Medication intended to bring color back to the affected area

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• A skin-grafting surgery called noncultured epidermal cell suspension
• Immune-targeting therapy to reverse the condition

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• Gene therapy that reprograms melanocytes to prevent an autoimmune reaction

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In addition to the investigation of these novel treatments, much of the latest vitiligo research has focused on gaining a better understanding of the genes involved with how the condition starts in the first place. By doing so, researchers hope to get closer to developing a treatment that prevents vitiligo from occurring or spreading.

Since something in the environment appears to be responsible for triggering vitiligo (as people are not born with the condition), researchers have also focused on understanding what those triggers are and why they incite such a response within the cells.

Why People With Vitiligo Are Joining the Body Positive Movement

While some people with vitiligo seek treatment to cover up or repigment their skin, others choose to embrace the condition however it shows up. Ash Soto from Orlando, Florida, falls into that camp. She documents her experience with vitiligo on her Instagram page, which has more than 130,000 followers.

Soto was diagnosed with vitiligo at age 12 after she saw a white spot on her neck and then noticed another one appear within a few months. “I remember being really scared and confused,” she says.

Soto admits she was teased at school for the way her skin looked and says her vitiligo hurt her self-esteem and made her feel insecure. By her late teens, however, she had decided to embrace her skin and use it as a canvas for art, which she shares photos of on Instagram. Her photos are accompanied by inspirational captions that promote a love-yourself mentality.

As for Soto, she’s all for vitiligo being included in the body positive movement. “When I was younger, I didn’t have anybody to look up to,” she says. “It’s so important for us to raise awareness for kids who are being diagnosed now.”

Since vitiligo doesn’t usually go away over time, it’s important that vitiligo patients develop coping strategies by learning about the condition and connecting with others who are living with it, too.

• Vitiligo is an autoimmune disease in which the immune system attacks and kills the skin’s pigment cells, causing the skin and hair to lose pigment or color in different areas of the body.
• Although experts aren’t entirely sure what causes vitiligo, genetics and environmental triggers may play a role, and it affects people of all races and genders equally.
• Vitiligo is typically treated by a dermatologist using various topical medications and light therapy over time.
• Living with vitiligo can sometimes take an emotional toll, so seeking support for your mental well-being can also be an important part comprehensive care.