Hair turning prematurely gray or whiteEyelashes or eyebrows losing color and turning whiteChange of color in the retina of the eye, noted a study published in the November–December 2019 issue of the Indian Dermatology Online Journal Color loss in the nose and mouthInflammation of the ears or eyes, leading to hearing loss and vision problems, according to NIAMS
Where skin spots appear, how widespread the condition becomes, and how much it will progress vary from person to person. There are two major types of vitiligo:
Nonsegmental Vitiligo The most common type of vitiligo, with pale skin patches usually appearing on both sides of the body. The first signs may show up on hands, fingertips, wrists, around the eyes or mouth, or on the feet. Nonsegmental vitiligo is also called bilateral or generalized vitiligo or vitiligo vulgaris, according to an article published in September 2016 in the journal F1000 Research. Nonsegmental vitiligo is divided into subtypes based on the way the condition shows up. These include acrofacial vitiligo, which appears on the face, hands, and feet; mucosal vitiligo, which affects the mucus membranes of the mouth, nose, and genitals; localized or focal vitiligo, which occurs on just a few areas of the body; and universal vitiligo, which may involve 80 to 90 percent of an affected person’s skin, according to a review in the journal Dermatology.
Segmental Vitiligo For this type, white patches often appear on just one side of the body, such as one arm or one leg instead of both. Loss of hair color is common. Segmented vitiligo can begin early in life. It may spread rapidly for six months to two years, then stop progressing. In rare cases, this form of vitiligo may become active again years later. About 5 to 16 percent of vitiligo cases are segmental vitiligo, notes the Dermatology review.
You may also have mixed vitiligo, a combination of nonsegmental and segmental vitiligo. Importantly, vitiligo can cause significant psychological distress. Many people with vitiligo struggle with self-esteem, confidence, and social anxiety, especially if the vitiligo affects areas of the skin that are tough to hide under clothes or minimize with cosmetics, notes the NHS. “Vitiligo can have a significant effect on patients,” says Adrienne Haughton, MD, clinical assistant professor of dermatology and director of medical and cosmetic dermatology at Stony Brook Medicine in Commack, New York. “Patients can be very self-conscious and even experience depression.” Learn More About the Signs and Symptoms of Vitiligo So why might the body’s immune cells attack healthy skin cells in the first place? That question is still not entirely settled among researchers, according to the American Academy of Dermatology. But it seems likely that genetics and environmental triggers both play a role. These factors are known to increase risk for vitiligo:
Family History and Genes About 20 percent of people with vitiligo have at least one close relative affected by this skin disorder and researchers have found that having a certain genetic profile makes people more susceptible to developing vitiligo. Variations in over 30 genes have been identified that are associated with vitiligo, including two called NLRP1 and PTPN22, per MedlinePlus. These and other genes now linked with vitiligo are known to be involved with immune-system regulation and inflammation.Environmental Triggers Vitiligo seems to be the result of both a preexisting genetic makeup and something in the environment setting off an autoimmune response that destroys melanocytes. Potential triggers include sunburn, exposure to certain chemicals, and trauma or injury to the skin, according to the article in F1000 Research. These triggers can also prompt vitiligo to spread in people who already have the condition.An Existing Autoimmune Disease People with an autoimmune disease, such as psoriasis, systemic lupus erythematosus, Hashimoto’s disease, or alopecia areata, are at an increased risk of developing vitiligo, notes the American Academy of Dermatology. Several genes associated with vitiligo are also linked to other autoimmune conditions, such as rheumatoid arthritis, type 1 diabetes, and thyroid disease, according to NIAMS. Fifteen to 25 percent of people with vitiligo have another autoimmune disease, notes MedlinePlus.
Learn More About What Causes Some People to Get Vitiligo
Whether a close relative has been diagnosed with vitiligoWhether you have been diagnosed with an autoimmune disorderIf you’ve experienced recent stress (such as a major life change) or other potentially triggering events (such as a severe sunburn), per Mayo Clinic
Some dermatologists will want to do more testing beyond a skin exam. Your doctor may order a skin biopsy, which will show whether melanocytes are present in the skin. A lack of melanocytes is an indication of vitiligo. Your doctor may also ask for a blood test to see if you have another autoimmune disease.
Prognosis for Vitiligo
While this skin condition cannot be cured, treatments can slow or stop its spread, spur some regrowth of melanocytes, and improve the appearance of patchy skin by returning some color to white areas, notes NIAMS. Cosmetics can reduce the appearance of vitiligo patches, too. And cognitive behavioral therapy can help you overcome the depression and social anxiety that this skin condition so often causes, suggests the review in Dermatology. Nondrug and nonsurgical therapies include:
Makeup and self-tanners, which can cover up white patches and hair dye to bring color back to graying or white hairLight therapy, specifically narrowband UVB, according to Dr. Haughton
Medication and Surgery Options for Vitiligo
In 2022 the U.S. Food and Drug Administration approved ruxolitinib (Opzelura), the first medication that can restore pigment in patients with nonsegmental vitiligo. This is a topical JAK inhibitor, which works to reduce the activity of the immune system. In a clinical trial, 50 percent of patients experienced significant improvements after one year of using the medication.
Other medications may help minimize the appearance of vitiligo. These include:
Corticosteroid creams, prescribed for the short-term, per the AADOintments containing immunomodulators tacrolimus or pimecrolimus, which can be used longer-termTopical vitamin D analogs (which are synthetic versions of the vitamin)Combination therapy with UVA light and the oral medication psoralen, which may be especially effective if you have large areas of skin affected by vitiligo (This form of light therapy is effective but more difficult to administer than UVB, notes Mayo Clinic.)Pigment removal from unaffected skin using monobenzone cream
Some of these treatment options come with negative side effects, such as scarring, dry and itchy skin, and skin with a streaky appearance.
Alternative and Complementary Therapies for Vitiligo
There have also been a few research studies on alternative medicine options, such as treating the area with certain herbs and vitamins. But so far the studies have been too small to draw sweeping conclusions, says Hal Weitzbuch, MD, a dermatologist in private practice in Calabasas, California, and an adjunct professor of medicine at the University of California, Los Angeles. Don’t rely on unproven natural remedies instead of getting the medical care you need for vitiligo, he says. It’s also important to note that many individuals do not require or want treatment to minimize or conceal their vitiligo patches, since the visible patches pose no physical risks to people with them, says the Vitiligo Society. Your doctor or dermatologist can help you decide which treatment option, if any, is best for you. Learn More About How Doctors Diagnose and Treat Vitiligo
Prevention of Vitiligo
There’s currently no way to prevent the onset of vitiligo, but there are steps you can take that may help keep symptoms from worsening. In addition to the treatment options mentioned above, protect your skin from the sun and UV light by using sunscreen, seeking shade, and wearing clothing that protects you from harmful rays. Cuts, scrapes, and burns can trigger patches of vitiligo in some people, notes the AAD, as can getting tattoos. In general, try to avoid injuring your skin.
Vitiligo and Skin Cancer Risk
People with vitiligo — like the rest of the population — are encouraged to wear sunscreen (specifically a broad-spectrum, water-resistant option with an SPF of 30 or higher, per Mayo Clinic). Part of that is because skin without its natural color is more likely to burn in the sun. A function of melanin (the pigment that gives skin color, which is missing in patches of skin in people with vitiligo) is to help block out some of the sun’s dangerous ultraviolet rays, so skin without it may be more vulnerable to sun damage, according to the American Cancer Society. But sun protection is also important because avoiding getting tan can make vitiligo patches less noticeable, and some vitiligo treatments can be disrupted by sun exposure, notes the AAD. RELATED: Should You Really Wear Sunscreen Indoors? Since the skin in the vitiligo-affected areas can burn more easily, it may be surprising to learn that instead of increasing skin cancer risk, vitiligo is associated with lower risk. A University of Amsterdam study published in the British Journal of Dermatology found a threefold lower risk for melanoma and nonmelanoma skin cancers in people with vitiligo compared with those without it. There are a few theories for why this might happen. The same genes associated with vitiligo may also lower the risk of malignant melanoma, suggested a study published in Genome Medicine; a second theory posits that whatever’s causing the immune system to destroy melanocytes also causes it to destroy cancerous cells, notes the Vitiligo Clinic and Research Center at UMass Chan Medical School in Worcester, Massachusetts. RELATED: Everything You Need to Know About Skin Cancer It’s good news for people with vitiligo, but it doesn’t mean they should rely on their condition to give them absolute protection against the effects of the sun. Those with vitiligo simply don’t need to be any more worried about skin cancer than the rest of the population, Dr. Rodrigues says. Learn More About Vitiligo and Skin Cancer Risk
Vitiligo and Other Autoimmune Disorders
Up to one-quarter of patients with vitiligo have another autoimmune disease. If you have vitiligo, you may be at risk for an autoimmune disorder. So it’s important to discuss any new or unusual health issues you’re experiencing with your primary care practitioner. Vitiligo does not cause other autoimmune conditions, but it may share a genetic basis with one. Here are some of the most common autoimmune diseases associated with vitiligo:
Autoimmune thyroid diseaseRheumatoid arthritisType 1 diabetesPsoriasisPernicious anemiaAddison’s diseaseSystemic lupus erythematosus
Vitiligo and Mental Health Complications
The other concern when it comes to vitiligo complications is the emotional toll of living with a very visible skin condition, especially one that can begin early in life. “It’s a stigma — people have this aversion because it’s not ‘normal,’” says Sandy Skotnicki, MD, a dermatologist and assistant professor in the department of medicine at the University of Toronto. It can be especially difficult for people with darker skin, Dr. Skotnicki says, because the differences in skin tone are more obvious. For people with light skin, the presence of vitiligo may be less noticeable, Skotnicki adds. And for children and teens, it may be challenging to cope with vitiligo in the midst of other changes happening to their bodies, minds, and emotions — especially if their peers don’t understand or respond sensitively to what’s happening. For many, learning to deal with vitiligo means finding someone to talk to about the experience, whether that’s a trusted doctor, close family members and friends, or a mental health professional, noted an article published in the Indian Journal of Dermatology. Learn More About the Complications of Vitiligo: How It Affects Your Body in the Short and Long Term The disorder often begins early in life, with 25 percent of cases occurring in children younger than 10 years old, one-half happening in kids and teens younger than age 20 and up to 80 percent striking before age 30. It has developed infants and in adults as old as those in their mid-fifties, according to data in the Dermatology article mentioned above. Promising research is underway examining the genetic roots of vitiligo and testing compounds and treatments that may interrupt the autoimmune response, inflammation and the destruction of melanocytes. Areas of current vitiligo research include:
Medication that promotes the growth of melanocytesMedication intended to bring color back to the affected area, notes the Mayo ClinicA skin-grafting surgery called noncultured epidermal cell suspensionImmune-targeting therapy to reverse the condition, per the review in DermatologyGene therapy that reprograms melanocytes to prevent an autoimmune reaction, according to an article in Nature
In addition to the investigation of these novel treatments, much of the latest vitiligo research has focused on gaining a better understanding of the genes involved with how the condition starts in the first place. By doing so, researchers hope to get closer to developing a treatment that prevents vitiligo from occurring or spreading. Since something in the environment appears to be responsible for triggering vitiligo (as people are not born with the condition), researchers have also focused on understanding what those triggers are and why they incite such a response within the cells.
Why People With Vitiligo Are Joining the Body Positive Movement
While some people with vitiligo seek treatment to cover up or repigment their skin, others choose to embrace the condition however it shows up. Ash Soto falls into that camp. The twentysomething from Orlando, Florida, documents her experience with vitiligo on her Instagram page, which is over 150,000 followers strong. Soto was diagnosed with vitiligo at age 12 after she saw a white spot on her neck and then noticed another one appear within a few months. “I remember being really scared and confused,” she says. Soto admits she was teased at school for the way her skin looked and says her vitiligo hurt her self-esteem and made her feel insecure. By her late teens, however, she had decided to embrace her skin and use it as a canvas for art, which she shares photos of on Instagram. Her photos are accompanied by inspirational captions that promote a love-yourself mentality. The body positive movement is all about self-acceptance, so it’s been a natural fit for people who want to embrace their vitiligo. Some well-known people have been open about their vitiligo — including the model Winnie Harlow, the ballet dancer Michaela DePrince, Breanne Rice from The Bachelor, and actor Jon Hamm — and this has helped bring vitiligo into the spotlight, notes the Vitiligo Society. With this raised awareness, people may become more accepting of those living with the condition. As for Soto, she’s all for vitiligo being included in the body positive movement. “When I was younger, I didn’t have anybody to look up to,” she says. “It’s so important for us to raise awareness for kids who are being diagnosed now.” Since vitiligo doesn’t usually go away over time, it’s important that vitiligo patients develop coping strategies by learning about the condition and connecting with others who are living with it, too. With a membership of over 20,500 physicians worldwide, the AAD is dedicated to advancing treatment for dermatological conditions and advocating for patients. Their site offers a comprehensive, accessible overview of vitiligo, as well as information on treatment options and self-care tips. American Vitiligo Research Foundation Stella Pavlides started this charitable foundation in 1995 and has continued to run it since. Pavlides acknowledges that the condition can lead to bullying and insensitive comments from others, which makes it difficult to live with, especially for children. Her goal is to build public awareness of vitiligo, promote inclusion, and raise the spirits of those afflicted. The Foundation supports vitiligo research, hosts events, and shares information about vitiligo on its website. Vitiligo Support International The nonprofit organization promotes vitiligo research and treatment options. The treatments section of the site is particularly useful and outlines traditional options, including topical and surgical therapies, as well as more homeopathic ones. American Autoimmune Related Diseases Association (AARDA) Learn more about over 100 autoimmune diseases, including symptoms and how to get a diagnosis, on the website of this education and advocacy organization.
Favorite Vitiligo Blogs
Living Dappled What’s it really like to live with vitiligo? Erika Page, editor in chief of Living Dappled, shows you. She puts a refreshingly positive spin on living with vitiligo and fills the site with news about the condition, interviews, as well as practical tips about how to manage the condition every day. The site includes tips on how to care for your skin and how to cope with moments when you’re feeling down. ‘Speaking of Vitiligo …’ This blog is run and written by John E. Harris, MD, PhD, associate professor in dermatology and director of the Vitiligo Clinic and Research Center at the University of Massachusetts Medical School in Worcester. Dr. Harris shares his takes on new treatments, unanswered research questions, and what’s going on in the vitiligo community.
Favorite Vitiligo Support Networks and Online Communities
Daily Strength Daily Strength hosts support groups for many different types of health issues and conditions. The vitiligo page offers a place for people with vitiligo to connect about their experience and discuss everything from treatments that have worked for them to worries and fears about managing the condition. VITFriends Interested in connecting with other people with vitiligo? Visit the “support group” page of this site and click on the city nearest you for information about local support groups. Vitiligo Friends Vitiligo Friends is a network of more than 7,000 members. The online community has been active since 2007. You’ll need to sign up to become a member, but once you’re approved, you’ll have access to message boards where you can connect with other members and lean on one another for support.
Favorite Camp for Kids With Vitiligo
AAD Camp Discovery This weeklong camp from the American Academy of Dermatology is open to children between ages 8 and 16 who have a chronic skin condition, such as vitiligo, alopecia, or psoriasis. All fees for camp, including transportation, are covered by the AAD. A dermatologist’s referral is needed to attend. AAD Camp Discovery takes place in five locations each summer and gives children the opportunity to swim, fish, horseback ride, and have fun. A dermatologist is on site to ensure each child’s health needs are met. With additional reporting by Sari Harrar.
