Vitiligo: Managing and living with this challenging skin condition

Vitiligo is a chronic condition that affects skin color. Because vitiligo affects physical appearance, living with the condition can be challenging and can affect emotional well-being.

What is vitiligo?

Vitiligo is a lifelong condition in which patches of skin lose color due to the destruction of melanocytes, the cells responsible for producing melanin. Melanin is the pigment that gives skin its color. Vitiligo can appear on any body part and affects individuals of any age, ethnicity, or gender.

Quick facts about vitiligo:

• About 30% of people with vitiligo have a family history of it.
• It occurs in about 1% to 2% of the population.
• About half of people with vitiligo show symptoms before age 20.
• In one out of every five to 10 people with vitiligo, some or all the pigment eventually returns, causing the white patches to disappear.

What causes vitiligo?

Vitiligo is believed to be an autoimmune disorder in which the immune system mistakenly targets and destroys its own cells. In the case of vitiligo, the immune system targets an individual's melanocytes, the cells that produce skin pigment. In addition, the melanocytes in a person with vitiligo may be less capable of managing an imbalance between antioxidants and harmful free radicals in the body. In both cases, the melanocytes are damaged and destroyed, resulting in patches of skin losing pigment or color.

Although most individuals with vitiligo are otherwise in good health, there is a link between vitiligo and thyroid disorders, such as hyperthyroidism or hypothyroidism.

What does vitiligo look like?

In vitiligo, patches of skin lose their pigment, resulting in areas that appear milky white or lighter than the surrounding skin. The edges of the patches can look smooth or irregular and may show redness or brownish discoloration.

Vitiligo can appear anywhere on a person's skin. The areas most often affected are:

• the fingers and wrists
• in the armpits
• groin and genitals
• around the mouth and eyes
• inside the mouth.

Vitiligo can also cause loss of pigment in hair on the scalp, eyebrows, eyelashes, beard, and body hair.

Vitiligo can be particularly noticeable on darker skin due to the contrast between affected and unaffected areas. In lighter-skinned individuals, the lack of pigment often becomes more apparent in the summer, when surrounding skin tans while the vitiligo patches do not.

Types of vitiligo

There are two main types of vitiligo: non-segmental and segmental.

Non-segmental vitiligo is the most common type, affecting up to 90% of people with vitiligo. This type progresses slowly, with new patches forming periodically on both sides of the body, often symmetrically, such as on both knees or hands.

Segmental vitiligo is less common but is more frequently seen in children. This type is more localized, causing rapid pigment loss on one side or part of the body. Segmental vitiligo usually stabilizes within six to 12 months, after which no new patches develop.

In rare instances, vitiligo can spread to cover the entire body, a condition known as universal vitiligo.

Diagnosing vitiligo

To diagnose vitiligo, your doctor will review your medical history and conduct a thorough skin examination. In some cases, an ultraviolet light called a Wood's lamp is used to highlight areas of depigmentation, which appear chalky and bright under the lamp.

Your doctor may perform other tests such as:

• blood testing to check for other autoimmune diseases
• an eye exam to detect uveitis, an eye inflammation associated with vitiligo.

A skin biopsy, in which a small skin sample is examined in a laboratory, is rarely necessary. It can help confirm the diagnosis if the skin changes suggest other conditions.

Treatment options

Although there is no cure for vitiligo, there are treatments to help stop disease progression, restore skin color, and prevent new patches. For most people, the whitened skin patches last and grow larger if vitiligo is not treated.

Your doctor's recommendations for treatment will depend on your needs, overall health, and vitiligo type.

Topical medications. Topical treatments include topical steroids, topical calcineurin inhibitors (such as tacrolimus or pimecrolimus), and topical vitamin D analogs (such as calcipotriene). These prescription medications are applied directly to the skin.

Ruxolitinib (Opzelura) is a newer medication approved by the FDA in 2022 to restore lost skin color in people with vitiligo. This cream is a Janus kinase (JAK) inhibitor that is prescribed for individuals ages 12 and older primarily to treat small areas of vitiligo. Clinical trials have shown that ruxolitinib cream can effectively repigment the skin, with results lasting up to two years.

Light therapy. This treatment exposes the skin to ultraviolet light, encouraging repigmentation. Ultraviolet light can be provided by a hand-held lightbox for smaller areas of skin, or delivered in a closet-sized lightbox if a larger area of skin is involved. The treatment must be repeated often, usually three times a week for at least six months.

Depigmentation. This approach, which involves lightening unaffected skin to match the depigmented areas, is only used for people with severe vitiligo. This treatment is rarely used because the depigmentation is permanent and the skin without pigment is vulnerable to damage from sun exposure.

Surgery. Surgical options like skin grafts or melanocyte transplants may be explored in severe cases or those that don't respond to other treatments. Surgery is not suitable for everyone, particularly people prone to scarring.

Protecting and caring for your skin if you have vitiligo

If you have vitiligo, protecting your skin from the sun is crucial to managing the condition. Vitiligo-affected skin is more susceptible to sunburn and skin cancer.

To protect your skin, stay out of the sun, wear sun-protective clothing, and apply sunscreen daily to all exposed skin. Avoid tanning beds and sun lamps, as they can worsen vitiligo.

In addition, skin injuries such as cuts, scrapes, and burns can trigger new spots or patches of vitiligo, so you should take care to protect your skin.

Living with vitiligo

Some people embrace their natural skin with vitiligo. Others may not be comfortable with their appearance and may use makeup, self-tanner, or skin dye to cover light patches. Vitiligo can affect quality of life, leading to stress, sadness, and low self-esteem.

If vitiligo is affecting your mental health, seek psychological support and counseling. A mental health professional can provide valuable support for coping with difficult feelings and managing depression. It may also be helpful to connect with others by joining a vitiligo support group or seeking emotional support from family and friends.