Vitiligo
What is vitiligo?
Vitiligo is a skin pigmentation disorder that shows up as smooth, white, painless spots or patches on various parts of the body. The white areas are due to loss of the pigment (melanin) that gives the skin its colour and protects it from the sun’s ultraviolet (UV) rays. The hair in the affected areas may also turn white.
Vitiligo is not contagious. It is a common condition that affects between 1 and 2 per cent of people worldwide, with most people who develop vitiligo doing so before the age of 40. Vitiligo generally affects both men and women equally.
What are the symptoms of vitiligo?
Vitiligo is first noticed with the appearance of flat white spots or patches on the skin. The white patches are more commonly seen in areas that are exposed to the sun, such as the hands, arms, face and lips. However, vitiligo may occur in other areas such as the armpits, groin, mouth, eyes, nose and inside the nose, navel area and the genitals.
In addition, some people will notice white patches appearing inside their mouth and may have premature greying of the scalp hair, eyelashes, eyebrows or beard.
There is no way to tell if the condition will spread from the original site; however, generally other patches will appear on other parts of the body. This may occur slowly, but for some people it happens rapidly. Factors such as stress, physical illness, pregnancy and severe sunburn may trigger a worsening of vitiligo.
People with vitiligo may find that white patches sometimes revert to normal skin colour without any treatment; however, this does not usually happen to all affected areas.
What causes vitiligo?
The cause of vitiligo is not fully known but there are a number of theories.
One theory suggests that people who develop vitiligo may develop antibodies which, instead of protecting them against UV rays, actually turn against them, destroying the special cells that produce the pigment in the skin (these cells are called melanocytes).
Another theory suggests that the melanocytes attack and destroy themselves.
It has also been suggested that some cases of vitiligo may occur after severe sunburn or an episode of emotional distress.
In some cases, vitiligo is associated with autoimmune disorders — conditions in which your immune system attacks your own tissues. In some people with autoimmune disease, the immune system may attack and destroy the cells that produce melanin, causing vitiligo.
Autoimmune disorders that have been linked with vitiligo include:
- hyperthyroidism (overactivity of the thyroid gland);
- adrenal insufficiency (the adrenal gland does not produce enough of the corticosteroid hormones);
- alopecia areata (patches of baldness);
- pernicious anaemia (a decrease in red blood cells due to the body not being able to absorb vitamin B12 from food); and
- diabetes mellitus.
In some cases vitiligo seems to be inherited and run in families, with children whose parents have vitiligo being at increased risk of developing the condition themselves.
How is vitiligo diagnosed?
Your doctor will use a number of methods to diagnose vitiligo.
- Checking for a family history of vitiligo.
- Identifying previous trauma to the site (such as sunburn).
- Checking if you or a family member has an autoimmune disease.
- Biopsy of the affected skin (taking a small sample of skin to examine in the laboratory).
- Blood tests to check cell count, thyroid function and autoantibodies (protein-like substances produced by the immune system that attack a person’s own tissue in autoimmune disease).
- Occasionally, eye examination for uveitis (inflammation of the front portion of the eye).
How is vitiligo treated?
The aim of treating this condition is to improve the skin’s appearance and to stop new patches forming. However, treatment for vitiligo tends to take a long time — usually 6 to 18 months, and will probably not return all your skin to its normal colour.
The most common forms of treatment include:
- corticosteroid creams or ointments;
- treatment with a combination of either topical or oral psoralen and UVA light (photochemotherapy);
- exposure to a specific wavelength of UVB radiation (narrowband UVB phototherapy);
- depigmentation (fading the rest of the skin to match the already white areas); and
- surgical procedures including transferring skin from unaffected areas of your body to the areas affected by vitiligo (autologous skin grafts).
In addition, your doctor or dermatologist (skin specialist) may also recommend:
- camouflage measures such as makeup, stains or self-tanning lotions;
- sunscreens to protect your skin; and
- in some cases, avoiding things that cause excessive friction on the skin, such as jewellery and wrist bands.
Many people with vitiligo suffer emotional and psychological problems because of the appearance of their skin. Some people may require counselling for these emotional problems.
What you can do
- Consult a doctor if you notice flat, whitish patches on your skin.
- Follow your doctor or dermatologist’s advice regarding treatment and looking after your skin.
Last Reviewed: 06 August 2007
