Vitiligo

What is Vitiligo?

Vitiligo is a disease that causes people to lose color in areas of their skin, resulting in spots and patches of lighter skin. Some people develop a few spots and others have more widespread color loss. Vitiligo is an autoimmune disease, meaning that the immune system mistakenly attacks some part of the body. Dermatologists can offer treatments to help restore lost skin color.

What are the signs and symptoms of vitiligo?

Vitiligo can develop anywhere on a person's skin. When vitiligo starts, the patches usually appear on the face, arms, hands or feet.

In time, the spots and patches can grow, and vitiligo can appear on other areas of the body. Vitiligo can also affect the hair, causing white or prematurely gray hair. The most noticeable sign of vitiligo is one or more areas of lighter skin. For many people, that’s the only sign of vitiligo. However, other signs and symptoms can also develop.

Vitiligo most often affects the face, elbows and knees, back of the hands and feet, and genitals. It usually affects both sides of the body equally. People of any skin color can develop vitiligo. The contrast between someone’s natural skin color and the lighter patches can make it more noticeable when the person has a darker skin tone or a tan.

What causes vitiligo?

Vitiligo is an autoimmune disease. This type of disease develops when your immune system attacks part of your own body. If you have vitiligo, your immune system attacks cells in your body called melanocytes - these are cells that make pigment and give color to your skin.

The exact cause of vitiligo is not known. It can appear at any age. While having a close family member with vitiligo increases your risk of developing it, not everyone who has vitiligo in their family develops this disease.

Depending on where in your body the immune system destroys these pigment-making cells, you can have:

• Lighter patches and spots on your skin
• Loss of color inside or around your mouth, lips, or nose
• Hair on your head turn prematurely gray or develop a white streak
• Part (or all) of an eyebrow or eyelash turn white
• Loss of color in part of an eye
• Hearing loss, as the inner ear contains melanocytes

If the body continues to attack melanocytes, the patches will grow, and new spots and patches can appear in other areas.

Who gets vitiligo?

People of all races and skin colors can get vitiligo, and the disease occurs about equally in people of all races. About half of the people who develop vitiligo get it before 20 years of age. For many of these people, vitiligo begins when they’re a child. Children who develop vitiligo often have a relative with this condition.

While vitiligo can run in families, having a close relative with vitiligo doesn’t guarantee that you will get vitiligo. A number of genes are involved. Inheriting certain genes may increase the risk of something triggering vitiligo.

Known vitiligo triggers include:

• A severe sunburn
• Injured skin (cut, scrape, burn)
• Getting a strong chemical like phenol on your skin

What increases the risk of getting vitiligo?

Some people have an increased risk of developing a type of vitiligo called non-segmental vitiligo. This is the most common type of vitiligo. Your risk increases if:

• You have close relatives with vitiligo
• You have close relatives with certain other autoimmune diseases, especially ones that affect the thyroid or alopecia areata.
• You have melanoma (the most serious type of skin cancer) or non-Hodgkin lymphoma (cancer of the lymphatic system).
• You are being treated for melanoma with immunotherapy.

If you see white patches and spots on your skin, it’s important to find out if you have vitiligo. This disease increases the risk of having some other autoimmune diseases like thyroid disease and alopecia areata. Some people develop hearing loss or a problem with their vision.

If you have vitiligo, your Tono dermatologist can help you treat the condition. Your Tono doctor can also monitor you for other diseases and refer you to other doctors if necessary. This can help you look and feel your best.

What are the treatments for vitiligo?

If you have vitiligo and want to get treatment, your Tono doctor can help you create a treatment plan to try to restore lost skin color, stop the patches and spots from getting bigger, and stop new spots from appearing.

There is not one best treatment for vitiligo. Before creating a treatment plan, your doctor will work with you to find the treatment that is best for you. To do this, your doctor considers your age, overall health, and effects the disease has on your life. The type of vitiligo, where it appears on the body, and how it’s progressing, will also play a role in developing the right treatment plan.

It’s important to remember that vitiligo is difficult to treat, and treatment works slowly. Treatment options include:

• Medication that you apply to your skin. These topical medicines may promote repigmentation in affected skin, especially when applied soon after the condition first appears. These include topical corticosteroids, topical tacrolimus or pimecrolimus, calcipotriene, or ruxolitinib cream.
• Light or phototherapy, can also help restore lost skin color. Phototherapy uses a specific type of ultraviolet light that is filtered to deliver just the wavelengths most useful for stimulating re-pigmentation. Exposure to these focused ultraviolet rays can increase the number of melanocytes in areas of skin affected by vitiligo and prevent new white patches from forming.
• Laser therapy, such as the excimer laser, is another treatment that is helpful if you need treatment targeted to a certain part of your body. A laser can target smaller sections of skin, so there is less effect on skin that doesn’t need treatment.
• Oral medication can sometimes be helpful if your vitiligo is spreading more rapidly. Your doctor may prescribe a medication by mouth for a short period of time to help slow down the disease.
• Surgery may be an option if other treatments fail to restore skin color. Skin may be grafted from normally pigmented areas and placed onto areas where there is pigment loss. Cell transplants are another type of surgery that can be used to help with skin re-pigmentation. Surgery is usually not recommended for people who have active vitiligo, which means that new spots have appeared or existing spots have grown over the last 12 months. Surgery may also cause scarring.
• Camouflage makeup, self-tanner, and skin dyes are another option that can help even out your skin tone right away. Getting results from treatment takes time. To help you even out your skin tone until you get results, or if you decide not to treat vitiligo, your dermatologist can recommend using one of these products.

Vitiligo can be stubborn, but the right treatment can help. Your Tono dermatologist will work with you to design the best treatment plan for you.