Vitiligo: Causes, Symptoms and Treatment

Vitiligo is a skin condition where an area of skin loses its colour, so it looks different to your normal skin tone. These patches of skin look white or pink depending on your natural skin tone. Vitiligo is caused by a lack of melanin. Melanin is the substance that gives your skin its colour.

It is common to get vitiligo on:

• the face, neck or hands
• creases of the skin

You can get vitiligo on any area of the body. If the sun damages the patches, this can cause more severe skin conditions, so it is essential to protect all vitiligo patches from the sun.

Vitiligo is also known as leucoderma. It is a long-term condition that can affect anyone regardless of age, ethnicity or gender, but it can be more noticeable on darker skin.

We don’t know what causes vitiligo, but it is not contagious, harmful or a sign of cancer, albinism or leprosy.

How common is vitiligo?

A medical review from 2019 shows that vitiligo affects under 1% of the population worldwide, although this figure may be higher due to people not reporting it. Most people (estimated at 95% by the Vitiligo Society) who develop vitiligo will do so before they’re 40 years old.

The main symptom of vitiligo is skin patches that look different from the rest of your skin.

Vitiligo patches:

• are usually permanent
• can be white or pink, depending on your natural skin tone
• usually develop slowly over time
• vary in size and extent from person to person
• are not painful (although they can be itchy)

You can find the patches all over your body, but they are most commonly found on the:

• eyes
• mouth (inside and outside)
• wrists and fingers
• groin area and genitals
• armpits

You can also get patches where you have hair roots, making your hair white or grey. The patches may be a few small spots in some people, whereas others can have larger patches that join up.

There are two different types of vitiligo, depending on what the patches look like:

1. Non-segmental vitiligo

• the most common form
• can occur all over the body, often with symmetrical patches
• also known as bilateral or generalised vitiligo

2. Segmental vitiligo

• occurs only in one area of the body
• less common but often starts earlier
• thought to affect 3 in 10 children with vitiligo
• also known as unilateral or localised vitiligo

What are the early signs of vitiligo?

Vitiligo can start as a patch of skin that is paler than your usual colour and gradually turns completely white. As it spreads, the centre may remain white but become surrounded by lighter skin. It is impossible to predict if the patches will spread and where to.

Vitiligo patches can also be pink if there are blood vessels under the skin.

Are there complications from having vitiligo?

Vitiligo is not life-threatening, but it can cause other health problems.

• The lack of pigmentation means the skin can burn more quickly in the sun.
• If people do not like the appearance of their skin, it can impact their self-esteem and mental health.
• Inflammation of the eyes and a partial loss of hearing is often linked to vitiligo.
• The Vitiligo Society estimates that 15-25% of people with vitiligo have an autoimmune disease such as rheumatoid arthritis, type 1 diabetes or an overactive thyroid gland.

According to a medical review from 2016, over 50% of people with vitiligo experience relationship problems. The Vitiligo Society is an excellent place to get advice on living with vitiligo.

When should I talk to a doctor about my vitiligo?

You should speak to your doctor if you notice any sudden changes in your skin or if you have an issue with your skin that’s affecting your physical or mental health. Skin conditions can also be a sign of an underlying health condition, so even if it isn’t bothering you, it’s still worth speaking to a doctor.

Vitiligo occurs when there is no melanin in the skin. Cells in your skin called melanocytes produce melanin. If you have vitiligo, that particular patch of skin does not have enough melanocytes to produce melanin.

It’s not known exactly why the melanocytes disappear from the areas of skin where you get vitiligo. It is thought that non-segmental vitiligo is an autoimmune condition ( when the immune system has attacked the healthy cells producing melanin). Segmental vitiligo may be linked to chemicals released from the nerve endings in your skin, but this has not been confirmed.

What increases your risk of vitiligo?

As it’s not known what causes your skin to develop vitiligo, it is not clear what the risk factors are. However, doctors believe a combination of genetic and environmental conditions can trigger it:

• family history of vitiligo or autoimmune conditions
• stress
• hormonal changes such as adolescence
• exposure to certain chemicals such as carbolic acid or phenic acid
• damage to the skin from the sun or cuts
• liver/kidney conditions
• cancers such as melanoma (a type of skin cancer) or non-Hodgkin lymphoma

Vitiligo is not contagious. You cannot catch it from someone else or pass it on.

You cannot diagnose vitiligo yourself. Your doctor will examine your skin, take your medical history and possibly use a UV lamp (called a Wood’s lamp) to look more closely at the patches before they diagnose you. They may ask you about any stressful events, contact with chemicals and skin damage you have experienced. You can also get Vitiligo diagnosed online with Superdrug Online Doctor. You simply have to complete a short health questionnaire, upload photos of your skin, and our doctors can provide a diagnosis.Due to the link between vitiligo and other auto-immune diseases, the doctor may also ask you questions and order blood tests to work out if you have another condition.As vitiligo can have a negative impact on mental health, your doctor may talk to you about how you are feeling and suggest ways to help.

There is no cure for vitiligo. You may decide that you don’t want to change your appearance, but if you do, treatments are available to make the patches of vitiligo look more similar to your natural skin tone. Most of these are not permanent.

Protection from the sun & Vitamin D supplements

If you have vitiligo, it is essential to protect the patches from the sun to avoid more severe skin damage. This is because without melanin in the skin, there is no natural protection from the sun’s rays. We absorb a majority of our Vitamin D from being exposed to the sun, so if your vitiligo means you’re avoiding the sun, you may need to consider Vitamin D supplements.

Camouflage cream

These are waterproof creams that are the same colour as your normal skin tone. They usually last 12 to 18 hours on the face and up to 4 days on the body. The NHS may refer you to Changing Faces, who specialise in camouflage creams if you want them.

Topical steroids

A topical steroid can stop the spread of the patches and restore the pigmentation to your skin. As they can have serious side effects, a doctor who understands your medical history and condition must prescribe them. Examples of topical steroids include fluticasone propionate, betamethasone valerate and hydrocortisone butyrate.

Referral to a dermatologist

Your doctor may refer you to a dermatologist if:

• the treatments you have tried have not worked
• you cannot use the medicines prescribed
• you are pregnant
• you have vitiligo on the face
• you are under 18

A dermatologist can consider many different therapies to help manage vitiligo. These include phototherapy, skin grafts, depigmentation and medicines called calcineurin inhibitors.

Doctors cannot predict when someone will get vitiligo, so you cannot prevent it from appearing on your skin. However, the sooner you see a doctor after vitiligo appears, the greater the chance of a treatment that can slow its development or help you adjust to your new appearance.

Other skin conditions are similar to vitiligo. Your doctor will use the UV lamp (a Wood’s lamp) to examine your patches carefully to ensure they are vitiligo and not something else.

Talk to your doctor to understand your skin condition and how to treat it.

The following conditions can be confused with vitiligo:

• pityriasis alba: patches show a more gradual loss of pigmentation compared to the total loss of pigmentation in vitiligo; common mainly in children and young adults, and on the face
• tinea versicolor: patches are similar to vitiligo in terms of the lack of pigmentation, but they are usually dry and flaky, whereas vitiligo patches feel the same as the rest of the skin
• hypopigmentation: this is the term given to any patches of skin which don’t have melanin; vitiligo is one type of hypopigmentation, but there can be others (e.g. albinism)
• white birthmark: a birthmark is usually present either at birth or within a few weeks, whereas vitiligo usually develops in the second or third decade of life