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Vitiligo

Definition

Vitiligo is a skin condition in which there is a loss of brown color (pigment) from areas of skin, resulting in irregular white patches that feel like normal skin.

Causes, incidence, and risk factors

Vitiligo appears to occur when immune cells destroy the cells that produce brown pigment (melanocytes). This destruction is thought to be due to an autoimmune problem, but the cause is unknown.

Vitiligo may appear at any age. There is an increased rate of the condition in some families. The condition affects about 1 out of every 100 people in the United States.

Vitiligo is associated with three other autoimmune diseases:

• Addison's disease
• Hyperthyroidism
• Pernicious anemia

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, hands and feet, and genits. 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.

Signs and tests

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

Sometimes, a health care provider may use a Wood's 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 doctor may also perform blood tests to check the levels of thyroid or other hormones, 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.
• Medicines applied to the skin, such as:
  • Corticosteroid creams or ointments
  • Immunosuppressant creams or ointments, such as pimecrolimus (Elidel) and tacrolimus (Protopic)
  • Topical drugs such as methoxsalen (Oxsoralen)

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 health care 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 resort.

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 and use appropriate safeguards against sun exposure.

Support Groups

• American Vitiligo Research Foundation -- www.avrf.org
• National Vitiligo Foundation -- www.nvfi.org
• VitiligoSupport.com -- www.vitiligosupport.org

Expectations (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.

Complications

Depigmented areas are more likely to sunburn and develop certain skin cancers.

Calling your health care provider

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

Prevention

References

Habif TP. Light-related diseases and disorders of pigmentation. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 19.