Vitiligo

What do you want to know about vitiligo?

This article contains public sector information licensed under the Open Government Licence v3.0.

What is vitiligo?

Vitiligo is a disease that causes the skin in some parts of the body to lose its colour. The medical term that is used to describe skin that has become lighter or lost its colour is called hypopigmentation

When people with vitiligo lose the colour in their skin, they start to develop white patches of skin in different parts of their body. Usually, the white patches first develop on the:

  • Fingers
  • Knuckles
  • Eyes
  • Mouth
  • Feet 
  • Genitalia
Man with vitiligo on his hands holding up his hands in front of his face.

Vitiligo is categorised as an autoimmune disease. An autoimmune disease is a disease that develops when the body’s own immune system starts to accidentally attack other parts of the body. When this happens in vitiligo, the immune system attacks and kills specific skin cells called  “melanocytes”. Melanocytes are the cells in our skin that are responsible for producing something called “melanin”, which is the substance that gives our skin its colour. 

The more melanin you have, the darker your skin is. This means that people with dark skin have more melanin than people with light skin do.

Illustration of vitiligo skin with melanocytes and melanin, and also with no melanocytes and no melanin.

So when these melanocytes are attacked and killed off in people with vitiligo, they start to lose melanin in certain areas of skin that have been affected. This leaves them with white patches of skin that do not match their natural skin colour.

People with one autoimmune disease, such as vitiligo, also have an increased risk of developing other autoimmune diseases including:

  • Type I diabetes
  • Autoimmune thyroiditis
  • Rheumatoid arthritis
  • Addison’s disease

What are the different types of vitiligo?

There are two main types of vitiligo:

1) Non-Segmental Vitiligo (NSV)

2) Segmental Vitiligo (SV)

These two types of vitiligo can both create different patterns of lighter skin, and they can also develop in different parts of the body. 

Non-segmental vitiligo is a type of vitiligo that causes light patches of skin to develop in a symmetrical pattern. 

Non-segmental vitiligo (NSV) on the hands and fingers symmetrically.

The white patches of skin in non-segmental vitiligo usually develop in areas of skin that tend to experience pressure, friction or trauma, for example the: 

  • Back
  • Fingers 
  • Feet 
  • Wrists 
  • Elbows 
  • Armpits 
  • Around the mouth and eyes  

Non-segmental vitiligo can start at any age, and can get progressively worse throughout life.  

There are many different types of non-segmental vitiligo. These include:

  • Generalised Vitiligo: This is the most common type of non-segmental vitiligo, and it is also known as bilateral vitiligo. People with this type of vitiligo develop symmetrical patches of light skin. These symmetrical patches are randomly spread out across the body.

     

  • Acrofacial Vitiligo: This is the second most common type  of non-segmental vitiligo. The lighter patches of skin that develop here are usually found on the hands and feet, and around the nose, mouth, or eyes. Over time, acrofacial vitiligo can spread to other areas of the skin, and can gradually turn into generalised vitiligo.

     

  • Universal Vitiligo: This is when 80% to 90% of the skin loses its natural colour and develops lighter patches of skin. This type of vitiligo also affects the hair, and causes the hair to become white.  

     

  • Focal Vitiligo: This type of vitiligo causes small, lighter patches of skin to develop. These patches have no obvious pattern, and they usually remain unchanged for 1 to 2 years. 

     

  • Follicular Vitiligo: This is when the hair follicles and the skin surrounding the hair start to lose their natural colour and become lighter.

     

  • Mucosal Vitiligo: This is a type of vitiligo that causes  whitening of the skin in the mouth or genital area. The symptoms can either be spread across a wide area, or be localised to one place. 

Segmental vitiligo is also known as unilateral vitiligo. It commonly develops in children or young adults. Usually, this type of vitiligo gets progressively worse for about 1 to 2 years, and then it becomes stable. 

Segmental vitiligo on a man's back.

Normally, the lighter patches of skin in segmental vitiligo develop on the:

  • Neck
  • Chest
  • Back
  • Stomach
  • Groin
  • Buttocks

The light patches of skin in segmental vitiligo develop asymmetrically on the skin and the hair.

Segmental vitiligo usually develops rapidly (within 6 to 24 months). In the majority of people who develop it, segmental vitiligo usually starts as a single white patch.

Who usually gets vitiligo?

Anyone can get vitiligo. People who have different ethnicities, ages and skin colours can develop this condition. The disease is however, more noticeable in people with darker skin, because the contrast between the light and dark skin is more obvious.

Can both men and women develop vitiligo?

Both men and women can develop this skin condition. 

Women are however, more likely to seek a doctor when the symptoms first start to develop due to cosmetic reasons. 

A study done in a Baghdad Teaching hospital showed that on average, the symptoms of vitiligo first start to develop in people who are around 15 years old. The study also showed however, that vitiligo can start to develop in people anywhere between the ages of 2 years old to 29 years old.14

Vitiligo in both a man and woman standing side by side.

Women with vitiligo have reported that the white patches on their skin can improve during their pregnancy.

Yes they can. Vitiligo is the main hypo-pigmented skin disease in 46% of Iraqi children.1

Vitiligo is a skin condition that can be commonly seen in families. 

One research study showed that between 21% to 63% of people with vitiligo in Iraq had a family history of the skin condition.14

People living in the southern parts of Iraq have a higher risk of developing vitiligo. This is because of the higher levels of war pollutants and malnutrition. The water and vegetable fields in the southern parts of Iraq are often polluted with industrial waste from plastic dyes including Thiols, Phenols, and Quinones, which increases the chances of developing vitiligo.9

What causes vitiligo?

Melanin is a substance that is produced by specific cells in your skin called melanocytes. The amount of melanin that these melanocytes produce determines the colour of our hair, our skin and our eyes.

If these melanocytes become damaged, or if they die completely, they will produce less (or no) melanin. This reduced production of melanin causes certain parts of skin to become lighter, which leads to the development of vitiligo.

Genetics

 

Genetics can play a role in the development of vitiligo. This means that if your father, mother, or sibling has vitiligo, you are 7 to 10 times more likely to develop the skin disorder as well. 

People with vitiligo also have rare differences in their genes that can cause the melanocyte cells in the skin to die and no longer produce melanin.

Strand of DNA.

The environment

 

The environment can also play a role in the development of vitiligo. Exposure to certain chemicals can cause the skin to lose some of its pigmentation, and therefore lose its colour. Some of these chemicals are found in hair dyes, rubber products, and lubricating oil. 

Some chemicals that are associated with causing the loss of pigmentation in the skin include: 

  • Monobenzyl ether of hydroquinone (MBEH)
  • 4-tert-butylcatechol (4-TBC)
  • 4-tert-butylphenol (4-TBP)
  • 2,4-ditert-butylphenol (2,4-dTBP)
  • 4-tert-amylphenol (4-TAP)
  • para-phenylenediamine (PPD)

Your genetics and the environment often work together to cause the development of vitiligo.

Trees in a forest.

Skin tanning does not cause vitiligo. However, tanning does make vitiligo more noticeable because it darkens the skin that still has melanocytes, and this increases the contrast between normal skin and affected skin. 

There are no clear answers. Although there is an association between some viruses and vitiligo, it is not known for sure if a virus alone can cause this skin disease.

Hepatitis C & E, Human Immunodeficiency Virus (HIV), and the herpes zoster virus are all thought to be able to play a role in the initial development of the disease.

Also, Cytomegalovirus (CMV) and Epstein Barr Virus are often found on the skin of people with vitiligo.

As in the case of viruses, certain types of food do not cause the disease, but they can affect the development or the severity of the disease.

People who have diets that include a high amount of beef or lamb can have an increased risk of developing vitiligo. 

Chicken and fish are considered to have low-fat content and can be an alternative to beef or lamb.

Stress does not directly cause vitiligo,  but it can increase the chances of developing it.

What are the symptoms of vitiligo?

Everyone is affected differently by vitiligo. The severity and symptoms of this skin condition will differ from person to person.

The symptoms of vitiligo can include the following:

  • Chalky-white patches of skin that are not dry to the touch
  • Blue, tan, or grey skin that later turns white 
  • The white skin can also appear pink if there are blood vessels close to the surface
  • Edges of the white patch can be red or inflamed and can even have brown discolouration (hyperpigmentation)
Woman with vitiligo smiling and hugging herself.

Depending on the type of vitiligo someone has and the environment they are in, the disease can spread to other parts of the skin, or it can become stable and not spread.

Usually, areas of skin that have been injured (e.g. by sunburns or cuts) are more likely to become more affected by vitiligo. 

Yes, unfortunately people with vitiligo have an increased risk of developing certain types of cancer.

Breast and lung are common cancers in women with vitiligo, while prostate and liver are common in men. Both sexes can also develop colorectal cancer.

Yes. Many people who develop vitiligo, especially females and young adults, tend to suffer with mental health difficulties. 

Where can you get vitiligo?

The light patches of skin can develop anywhere on the body, but usually they are first noticed on the:

  • Fingers
  • Knuckles
  • Feet
  • Genitalia
  • The skin surrounding the eyes, nose, and mouth

As well as affecting the body, vitiligo can also affect the:

  • Hair 
  • Eyelashes
  • Eyebrows 

Which other conditions have similar symptoms to vitiligo?

There are some other conditions which can have similar symptoms to vitiligo. These include: 

Birthmarks can be present at birth, or they can appear soon afterward. The discolouration seen in birthmarks can vary in shape, colour, and location. They can be red, brown pink, purple, and even blue-grey. Some birthmarks can disappear naturally without needing any treatment.

This is a lifelong condition where people are born with little to no production of melanin. The whole skin, and sometimes even eyesight, are affected. This is an inherited skin disease, and people with albinism also have a high risk of developing skin cancer. 

This is a fungal infection that causes small patches of skin to become dry and discoloured. The skin discolouration in these infections develops gradually.

This is the development of itchy, white patches of wrinkled skin that is commonly seen on the genitals and anus, but that can also be seen in other parts of the body as well. The cause of this skin condition is not known.

In this disease, the melanocytes in the skin begin to break down, which causes lightening of the skin. The cause is not known, but it is seen mostly in the elderly, or in people with fair-skin.

Opposite to vitiligo, this is a condition where there is too much production of melanin, leading to darkening of the skin. The skin darkening is commonly seen on the face as symmetrical blotchy brown patches, but it can also occur on the arms and back.

Disclaimer

The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.

How do you treat vitiligo?

Although there is no cure for vitiligo, there are treatments available that try to stop the disease from appearing in more areas of the skin, and can also help with the social stigma associated with it.

There are many safe and effective treatments available. The type of treatment that is best for you will depend on which area of your skin has been affected, and the amount of skin lightening you have.

The most successful treatment areas are on the:

  • Face 
  • Trunk
  • Feet
  • Hands

Areas of the body with white hair tend to respond the worst. 

There are some things you can do at home to help your symptoms. These include:

  • Camouflage make-up – You can use make-up such as foundation or tinted moisturiser to cover any small areas of lightened skin.
  • Reduce injury to the skin – This can help reduce the risk of developing new lightened patches of skin. You can protect your skin from injury by being careful and by wearing protective clothing.
  • Sun protection – In order to reduce the risk of skin cancer developing, you should try your best to avoid direct sunlight, wear appropriate sun protective clothing, and regularly apply sunscreen to exposed areas.
  • Counselling – Some people who find that they are having trouble with their mental health may benefit from seeing a therapist or joining a support group.

There are some medications that can be used to help treat vitiligo. These include:

  • Topical corticosteriods: These are creams or ointments that can be applied directly to the skin. They are usually not used for longer than 3 months at a time. You should be careful when applying steroid creams to areas with thin skin, such as the neck, armpits, groin and face. Some examples of steroids that are used to treat vitiligo include: 

    • Fluticasone propionate
    • betamethasone valerate
    • hydrocortisone butyrate

  • Systemic immunosuppressants or calcineurin inhibitors

Topical corticosteroids, immunosuppressants, and calcineurin inhibitors are medicines that work by trying to slow down the progression and spread of the disease. 

WARNING: There is a high risk of developing a sunburn when using these medications. You should avoid too much sun exposure, and you should apply high-factor sunscreen with an SPF of 30 or above. These medications can also cause redness, inflammation, thinning of skin, and excess hair growth. Please speak to a doctor or dermatologist to understand all the potential side-effects before using any of these treatments.

This involves shining UVA or UVB light onto the skin using a special lamp. This therapy tries to stimulate melanocyte development and repigmentation. Light therapy is usually used continuously for at least 12 months before you begin to see results.   

WARNING: This treatment increases the risk of skin cancer. You should always speak to a dermatologist first before trying this treatment.

Surgical grafts are possible for people who have had stable symptoms for up to 1 year.

This treatment involves using special chemicals (such as monobenzone) to whiten the skin. This is done to lighten the rest of the natural skin, so that they blend in with the surrounding light patches of skin.

  • Afamelanotide: This is a hormone that stimulates melanocytes. Along with phototherapy, it can promote successful repigmentation.

     

  • Ruxolitinib: This is a medication that reduces inflammation. There is still research being conducted to determine if it is a useful treatment for vitiligo.

Can you prevent yourself from getting vitiligo?

It is not known if vitiligo can be prevented.  However, there are treatments available to help try to reduce the progression of the disease and decrease the likelihood of it developing.  

Can Vitamin D help treat vitiligo?

A daily supplement of Vitamin D is usually recommended as Vitamin D deficiency is common in those with vitiligo.

Is there a cure for vitiligo?

No, unfortunately there are currently no known cures for vitiligo. 

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