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Vitiligo

Autoimmune disorder - vitiligo

Vitiligo is a skin condition in which there is a loss of color (pigment) from areas of skin. This results in uneven white patches that have no pigment, but the skin feels like normal.

Causes

Vitiligo seems to occur when immune cells destroy the cells that make brown pigment (melanocytes). This destruction is thought to be due to an autoimmune problem. But, the exact cause of vitiligo is unknown.

Vitiligo may appear at any age. There is an increased rate of the condition in some families.

Vitiligo is associated with other autoimmune diseases:

Symptoms

Flat areas of normal-feeling skin without any pigment appear suddenly or gradually. These areas have a darker border. The edges are well defined, but irregular.

Vitiligo most often affects the face, elbows and knees, back of the hands and feet, and genitals. It affects both sides of the body equally.

Vitiligo is more noticeable in darker-skinned people because of the contrast of white patches against dark skin.

No other skin changes occur.

Exams and Tests

Your health care provider can usually examine your skin to confirm the diagnosis.

Sometimes, the provider may use a Wood light. This is a handheld ultraviolet light that causes the areas of skin with less pigment to glow bright white.

In some cases, a skin biopsy may be needed to rule out other causes of pigment loss. Your provider may also perform blood tests to check the levels of thyroid or other hormones, glucose level, and vitamin B12.

Treatment

Vitiligo is difficult to treat. Early treatment options include the following:

  • Phototherapy, a medical procedure in which your skin is carefully exposed to ultraviolet light. Phototherapy may be given alone, or after you take a drug that makes your skin sensitive to light. A dermatologist performs this treatment.
  • Certain lasers may help the skin repigment.
  • Medicines applied to the skin, such as corticosteroid creams or ointments, immunosuppressant creams or ointments such as pimecrolimus (Elidel) and tacrolimus (Protopic), or topical drugs such as methoxsalen (Oxsoralen) may also help.

Skin may be moved (grafted) from normally pigmented areas and placed onto areas where there is pigment loss.

Several cover-up makeups or skin dyes can mask vitiligo. Ask your provider for the names of these products.

In extreme cases when most of the body is affected, the remaining skin that still has pigment may be depigmented. This is a permanent change that is used as a last option.

It is important to remember that skin without pigment is at greater risk for sun damage. Be sure to apply a broad-spectrum (UVA and UVB), high-SPF sunscreen or sunblock. Sunscreen can also be helpful for making the condition less noticeable, because unaffected skin may not darken in the sun. Use other safeguards against sun exposure, such as wearing a hat with a broad rim and long sleeve shirt and pants.

Support Groups

More information about vitiligo can be found at:

Outlook (Prognosis)

The course of vitiligo varies and is unpredictable. Some areas may regain normal pigment (coloring), but other new areas of pigment loss may appear. Skin that is repigmented may be slightly lighter or darker than the surrounding skin. Pigment loss may get worse over time.

When to Contact a Medical Professional

Call for an appointment with your provider if areas of your skin lose their coloring for no reason (for example, there was no injury to the skin).

References

Habif TP. Light-related diseases and disorders of pigmentation. In: Habif TP, ed. Clinical Dermatology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 19.

Hadi SM, Spencer JM. Vitiligo. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 245.

Patterson JW. Disorders of pigmentation. In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap 10.

    • Vitiligo

      Vitiligo - illustration

      Vitiligo is a condition which involves complete loss of melanin, the primary skin pigment. The cause of vitiligo is unknown but it appears to be an acquired condition and may appear at any age. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face or it may be patchy. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.

      Vitiligo

      illustration

    • Vitiligo, drug induced

      Vitiligo, drug induced - illustration

      The white spots on this person's face have resulted from drug-induced vitiligo. Loss of melanin, the primary skin pigment, occasionally occurs as a result of medicines, as is the case with this individual. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.

      Vitiligo, drug induced

      illustration

    • Vitiligo on the face

      Vitiligo on the face - illustration

      This is a picture of vitiligo on the face. Complete loss of melanin, the primary skin pigment, occurs for unknown reasons. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face -- symmetrically -- or it may be patchy -- asymmetrical. The typical vitiligo lesion is flat (macular) and depigmented, but maintains the normal skin texture. The dark areas around the eyes are this person's normal skin color.

      Vitiligo on the face

      illustration

    • Vitiligo on the back and arm

      Vitiligo on the back and arm - illustration

      Vitiligo is characterized by patches of depigmented skin. Here, the contrast is seen very clearly. People with very light skin may not notice small areas of vitiligo. This person is receiving ultraviolet light treatment to help normalize the color of the skin.

      Vitiligo on the back and arm

      illustration

      • Vitiligo

        Vitiligo - illustration

        Vitiligo is a condition which involves complete loss of melanin, the primary skin pigment. The cause of vitiligo is unknown but it appears to be an acquired condition and may appear at any age. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face or it may be patchy. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.

        Vitiligo

        illustration

      • Vitiligo, drug induced

        Vitiligo, drug induced - illustration

        The white spots on this person's face have resulted from drug-induced vitiligo. Loss of melanin, the primary skin pigment, occasionally occurs as a result of medicines, as is the case with this individual. The typical vitiligo lesion is flat and depigmented, but maintains the normal skin texture.

        Vitiligo, drug induced

        illustration

      • Vitiligo on the face

        Vitiligo on the face - illustration

        This is a picture of vitiligo on the face. Complete loss of melanin, the primary skin pigment, occurs for unknown reasons. The resulting lesions are white in comparison to the surrounding skin. Vitiligo may occur in the same areas on both sides of the face -- symmetrically -- or it may be patchy -- asymmetrical. The typical vitiligo lesion is flat (macular) and depigmented, but maintains the normal skin texture. The dark areas around the eyes are this person's normal skin color.

        Vitiligo on the face

        illustration

      • Vitiligo on the back and arm

        Vitiligo on the back and arm - illustration

        Vitiligo is characterized by patches of depigmented skin. Here, the contrast is seen very clearly. People with very light skin may not notice small areas of vitiligo. This person is receiving ultraviolet light treatment to help normalize the color of the skin.

        Vitiligo on the back and arm

        illustration

      Review Date: 4/29/2016

      Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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