Vitiligo is a commonly acquired depigmentation of the skin due to autoimmune destruction of melanocytes. Well-circumscribed chalky-white macules and patches characterize it. The discolored areas usually get bigger with time. The condition can affect the skin on any part of the body. It can also affect hair and the inside of the mouth. Hair in the involved skin may be normal or white. The clinical manifestations of vitiligo include depigmented macules and patches on the skin, mucous membranes, and hair. White hairs in the involved area are associated with a poor prognosis.
Normally, the color of hair and skin is determined by melanin. Vitiligo occurs when cells that produce melanin die or stop functioning. The histology of vitiligo shows a normal epidermis with loss of melanocytes. A normal reticulate pigment network is due to melanocytes in the rete ridges. In vitiligo, destruction of melanocytes results in loss of the pigment network resulting in the dermoscopic glow. Vitiligo is not contagious.
Vitiligo affects people of all skin types, but it may be more noticeable in people with brown or Black skin. Vitiligo can start at any age, but usually appears before age 30. Vitiligo occurs in over 1% of the population throughout the world. While research is ongoing to learn more about the causes of vitiligo, studies indicate that about 30% of vitiligo cases are genetic. This means that the condition is hereditary and you could potentially inherit vitiligo from your biological family.
Causes Include
- An autoimmune condition: Your immune system mistakes healthy cells (melanocytes) as foreign invaders like bacteria that can cause harm to your body. This makes your immune system overreact and develop antibodies to destroy your melanocytes.
- Genetic changes: A genetic mutation or a change to your body’s DNA can affect how your melanocytes function. There are over 30 genes that can increase your risk of developing vitiligo.
- Stress: The amount of pigment your melanocyte cells produce may change if you experience frequent emotional stress or physical stress on your body, especially after an injury.
- Environmental triggers: Factors like ultraviolet radiation and toxic chemical exposure can affect how your melanocyte cells function.
Symptoms Include
- Patchy loss of skin color, which usually first appears on the hands, face, and areas around body openings and the genitals
- Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard
- Loss of color in the tissues that line the inside of the mouth and nose (mucous membranes)
You might be at a higher risk of developing vitiligo if you have certain autoimmune conditions like:
- Addison’s disease.
- Anemia.
- Diabetes (Type 1).
- Lupus.
- Psoriasis.
- Rheumatoid arthritis.
- Thyroid disease.
Types of Vitiligo
Generalized Vitiligo:
This is the most common type of vitiligo that causes macules to appear in various places on your body. The prevalence of GV is approximately 0.5% in various populations, with an average age of onset at about 24 years and occurring with approximately equal frequency in males and females. The concordance of GV in monozygotic twin-pairs is approximately 23%, and epidemiological evidence indicates that GV is a complex trait involving multiple genes and unknown environmental factors.
Segmental Vitiligo:
This type only affects one side of your body or one area, such as your hands or face. It is less common to have segmental vitiligo, which affects only about 5% of adults and 20% of children. Because this pattern is also characteristic of shingles, which typically affect the skin over just one nerve or “dermatome”. Segmental vitiligo is unique, even beyond the fact that it doesn’t cross the midline. It spreads very quickly, faster than the other forms, but only for about 6 months (sometimes up to a year).
It’s such a rapid pace that patients assume it will soon cover their entire body, but it stops abruptly and usually remains stable, without changing, forever after that. Segmental vitiligo also frequently turns the hair white in the affected spot pretty quickly, which is important because vitiligo spots with white hair usually don’t respond very well to treatment. That’s because the melanocyte stem cells, which can make more of the pigment-making cells, live in the hair follicles, but are most likely destroyed if the hair has become affected by vitiligo, turning white.
Mucosal Vitiligo:
Mucosal vitiligo affects mucous membranes of your mouth and/or genitals. Pure mucosal vitiligo accounts for 2.3% of total vitiligo cases and angle of lip accounts for approximately 12%–17% of total mucosal vitiligo cases.
Focal Vitiligo:
Focal vitiligo is a rare type where the macules develop in a small area and don’t spread in a certain pattern within one to two years. Progression 2 years after onset of focal vitiligo, occurs in 50% of the patients with eventual progression to non-segmental vitiligo. There seem to be no clinical signs that predict progression in focal vitiligo.
Trichome Vitiligo:
Trichrome vitiligo consists of an intermediate zone of hypopigmentation located between the depigmentation center and the normal unaffected skin. This type causes a bullseye with a white or colorless center, then an area of lighter pigmentation, and an area of your natural skin tone.
Universal Vitiligo:
This rare type of vitiligo causes more than 80% of your skin to not have pigment. Patients with universal vitiligo reported significantly more comorbidities than the patients with general vitiligo. The most frequently mentioned comorbidities were thyroid dysfunction, rheumatoid arthritis, diabetes mellitus, and alopecia areata. Patients with universal vitiligo seemed to experience rheumatoid arthritis more often (15%) than patients with general vitiligo (3%)
Drug-Induced Vitiligo:
Drug-induced vitiligo is similar to the non-drug-induced form of vitiligo and is likely due to a similar autoimmune process. It is also called drug-induced leukoderma. The most common causes of drug-induced vitiligo are immune-modulating, biologic or targeted medicines.
Drug-induced vitiligo has similar risk factors to those for non-drug-induced vitiligo. These risk factors include:
- Genetic factors
- Race — all races are affected
- Sex — both men and women are affected equally
- Age — drug-induced vitiligo tends to affect older patients than those seen with non-drug-induced vitiligo.
Affected individuals may also develop other autoimmune disorders — especially Addison disease, autoimmune thyroid disease (both hyperthyroidism and hypothyroidism), diabetes mellitus, pernicious anemia and alopecia areata.
There are other conditions that make your skin change or lose pigmentation, including:
Chemical Leukoderma
Exposure to some industrial chemicals causes damage to skin cells, resulting in linear or splotchy white areas of skin.
Tinea versicolor
This yeast infection can create dark spots that show on light skin, or light spots that show on darker skin.
Albinism
This genetic condition means that you have lower levels of melanin in your skin, hair and/or eyes.
Pityriasis alba:
This condition starts with red and scaly areas of skin, which fade into scaly lighter patches of skin.
Treatment
Treatment for vitiligo isn’t necessary, as the condition isn’t harmful to your body and is only cosmetic. If you have widespread vitiligo or your physical symptoms affect your emotional well-being, your healthcare provider can help you find a treatment option to create a uniform skin tone by either restoring color (repigmentation) or eliminating the remaining color (depigmentation) in your skin. Common treatments for vitiligo include:
Medications: There isn’t a specific medication to stop vitiligo from affecting your skin but there are certain drugs that can slow the speed of pigmentation loss, help melanocytes regrow or bring color back to your skin. Medications to treat vitiligo could include:
- Corticosteroids.
- Topical Janus kinase inhibitors.
- Calcineurin inhibitors.
Light therapy: Light therapy or phototherapy is the treatment to help return color to your skin. Your provider will use light boxes, ultraviolet B (UVB) lights or medical-grade lasers directed at your skin for a short amount of time. It can take several light therapy sessions to see results on your skin.
Combining oral psoralen medication and ultraviolet A light (PUVA) treats large areas of skin with vitiligo. This treatment is effective for people with vitiligo on their head, neck, trunk, upper arms and legs.
Depigmentation therapy: Depigmentation therapy removes the color of your natural skin tone to match areas of your skin affected with vitiligo. Depigmentation therapy uses the drug monobenzone. You can apply this medication to pigmented patches of your skin. This will turn your skin white to match the areas of your skin with vitiligo.
Surgery is a treatment option for people diagnosed with vitiligo. Surgical treatment could include:
- Skin grafts: Skin is taken from one part of your body and used to cover another part. Possible complications include scarring, infection or a failure to repigment. This might also be called mini grafting.
- Blister grafting: Blister grafting uses suction to create a blister on your skin and your provider will then remove the top of the blister to attach it to an area of your skin affected by vitiligo.
Surgery is not recommended if you have quickly spreading vitiligo, Scar easily or develop raised scars that grow larger than a wound (keloids).
About 10% to 20% of people who have vitiligo fully regain their skin color. This is most common among people who receive an early diagnosis before age 20/experience the peak of the condition spreading within six months or less/have symptoms mainly in their facial area.
It’s less likely that you’ll regain your pigment if you develop vitiligo symptoms after age 20/ have symptoms on your lips, limbs or hands.
As there could be several causes of vitiligo, there’s no known way to prevent it. You can reduce your risk of developing vitiligo by:
- Practicing safe sun exposure habits.
- Taking care of your skin by using a moisturizer daily.
- Avoiding stress or injury to your body.
- Managing any underlying autoimmune conditions.
