- Understanding the skin
- What is vitiligo and what causes it?
- Who gets vitiligo?
- What areas of skin are affected with vitiligo?
- How does vitiligo progress?
- What are the symptoms of vitiligo?
- What are the treatment options for vitiligo?
- Skin camouflage
- Treatments that aim to reverse the changes in the skin
- Treatment to de-pigment the skin completely
- Sunblock
- Are there any complications of vitiligo?
- Further help and information
- References
To understand the cause of vitiligo, it is useful to have a basic understanding of the skin. The skin has two layers - the epidermis and the dermis. Beneath the dermis is a layer of fat, and then the deeper structures such as muscles and tendons.
There are cells called melanocytes in the bottom of the epidermis which make a pigment called melanin. The melanin is passed to the nearby skin cells, which colours the skin and protects them from the sun's rays. Melanin causes the skin to tan in fair-skinned people. Dark-skinned people have more active melanocytes. The melanocytes are stimulated to make more melanin when exposed to sunlight.
What is vitiligo and what causes it?
Vitiligo is a condition where pale white patches develop on the skin. It is due to a lack of pigment (colour) in the affected areas of skin. Vitiligo does not make you feel ill. However, the appearance of vitiligo can be distressing. This is particularly so for darker-skinned people where white patches are more noticeable.
Areas of skin with patches of vitiligo have no or very few melanocytes. The melanocytes are either damaged or destroyed in the body. Therefore, melanin cannot be made and the colour of the skin is lost. It is not known why the melanocytes go from affected areas of skin. They may be destroyed by the immune system or self-destruct for reasons not yet known. It is thought to be an autoimmune condition. This means that the immune system (which normally protects the body from infections) does not work properly. Antibodies are produced that can destroy your skin cells that make melanin.
Who gets vitiligo?
About 1 in 100 people develop vitiligo. Men and women are equally affected. It can develop at any age. However, it begins before the age of 20 in about half of cases. There is some genetic factor involved and vitiligo may run in the family. About 1 in 3 affected people have some other family member who is also affected. Vitiligo is not infectious and you cannot catch it from affected people. It is not more common in any racial or ethnic groups.
What areas of skin are affected with vitiligo?
Any area of skin can be affected. However, the most common sites involved are the face, neck, and scalp. Other common sites include the backs of hands, front of knees, elbows and genitals.
It is often symmetrical in that patches may appear on similar places on each arm or leg. In the areas of the scalp that are affected, the hair too is affected, causing it to become grey or white.
Very rarely, vitiligo can affect your whole body. This is called universal or complete vitiligo.
How does vitiligo progress?
Small areas of milky-white skin usually develop first. The contrast between the vitiligo skin and normal skin varies. In fair-skinned people it may only be noticeable in summer when normal skin tans. The contrast is more noticeable in darker-skinned people.
The course and severity of vitiligo varies from person to person. Sometimes a few small patches develop slowly and progress no further. Sometimes a number of patches develop quite quickly and then remain static for months or years without changing. However, it is quite common for the white patches gradually to become bigger and for more patches to appear on other parts of the body. Large areas of the skin may eventually be affected.
There is no way of predicting how much of the skin will eventually be affected when the first patch develops. The white patches are usually permanent. Rarely, some patches of vitiligo may re-pigment and return to normal.
What are the symptoms of vitiligo?
People with vitiligo are usually well. Vitiligo is not sore or itchy. However, the appearance of the skin can be distressing, particularly if the face or the hands are affected. There is no natural protection from the sun in affected areas of skin. This means that skin affected by vitiligo burns much more easily than normal skin if exposed to sunlight.
What are the treatment options for vitiligo?
Although there is no cure for vitiligo, there are now treatments available which can slow down vitiligo and also improve it. Some people may not be concerned about the white patches of skin if they are in areas not noticeable to others. In fair-skinned people, avoiding tanning of normal skin can make patches of vitiligo much less noticeable.
Treatment options generally fall into four groups:
Skin camouflage - measures to cover or camouflage the affected skin.
Treatments that aim to reverse the changes in the skin.
Treatment to de-pigment the skin completely.
Sunblock and other means to protect the pale skin.
Skin camouflage
Skin camouflage uses special coloured cover creams that are put on the white patches of vitiligo. Skin camouflage does not alter the disease but improves the skin's appearance. The aim is to find a colour to match the colour of your skin. Some special cover creams can be prescribed on the NHS. The creams can disguise vitiligo very well which may greatly increase self-confidence. The British Red Cross provides a free Skin Camouflage Service (see below).
There are also self-tanning lotions available from pharmacies. These may also hide the vitiligo and can last several days before needing to be reapplied. However, they often do not provide an exact match for each skin colour. They may be most useful for large areas of vitiligo where matching the colour exactly to nearby skin is not needed so much. Fake tans can also be useful for areas where camouflage is less effective (for example, the back of the hands).
Treatments that aim to reverse the changes in the skin
Some treatments have been shown to slow down the progression of vitiligo, and some treatments cause affected skin to regain pigment and colour in some cases. No single treatment for vitiligo works well in all cases. The response to the various treatments is variable and can depend on the type of vitiligo. Your doctor will advise on treatments that may be worth trying. The following just gives a brief overview of current treatment options.
Steroid cream
This is sometimes prescribed for a limited period of time (initially 4-6 weeks) when a small patch of vitiligo first develops. It may prevent a smaller patch from getting bigger. Occasionally, skin colour may return over a treated area. Steroids work partly by suppressing the immune system (which probably attack the melanocytes). Long-term use of steroid creams can cause side-effects which include thinning of the skin and stretch marks. Steroid creams are not usually recommended to use on your face.
Tacrolimus cream
This can be used as an alternative to steroid cream. It has been shown to restore skin colour to some people with vitiligo. Tacrolimus also works by suppressing cells of the immune system in the skin. It seems to be most effective for vitiligo on the face. It can also be used on the skin of children.
PUVA treatment
PUVA stands for psoralen and ultraviolet A light. It involves taking a special medicine (a psoralen) which makes the skin very sensitive to light. The skin is then treated with ultraviolet A (UVA) light from a special machine in hospital. This treatment is very time-consuming. Treatment is needed twice a week for 6-12 months or more. PUVA may cause side-effects such as sunburn-type reactions or skin freckling. If colour does return to the white patches there is still a chance that it may go white again at a later stage.
Narrowband UVB phototherapy
This is another light treatment which is now used more commonly than PUVA. It uses ultraviolet B (UVB) light. As with PUVA, treatment is twice weekly but you do not need to take a medicine to sensitise the skin and the treatment sessions are much shorter. It is less damaging to the skin than PUVA.
Laser treatments
Laser treatment for vitiligo is currently not available under the NHS as it has not yet been shown to be an effective treatment in clinical trials.
Skin grafting
Grafting of normal skin to small patches of vitiligo has been tried. It is time-consuming and not always successful or available.
Complementary treatments
There is currently insufficient evidence to recommend any complementary treatments for vitiligo.
Treatment to de-pigment the skin completely
In some people with extensive vitiligo, a treatment may be considered to make the remaining normal areas of skin go white. This makes all the skin an even white colour. This is done only after a full discussion with a specialist. The removal of all the skin pigment is permanent and it takes about a year to complete.
Note: the use of sun beds is not recommended. The ultraviolet radiation from sun beds can damage your skin and people who use tanning devices are much more like to develop skin cancer (melanoma) than average.
Sunblock
A high-protection sunblock (factor 30 or above) should be applied to all areas of vitiligo exposed to sunlight. Sunburn can easily occur if the skin is not protected. Some brands of sunblocks are available on NHS prescription. It is also important to cover affected areas of skin when the sun is strong, especially in the middle of the day. For example, by wearing a wide-brimmed hat and long-sleeved clothing.
Are there any complications of vitiligo?
Vitiligo itself does not develop into any other condition. However, other autoimmune disorders (diseases caused by the immune system) are slightly more common in people with vitiligo. For example, thyroid problems, diabetes and pernicious anaemia. Most people with vitiligo do not have these but your doctor may suggest a blood test to rule them out.
Some people with vitiligo are embarrassed about their condition. This can lead to low self-esteem and even depression. Some people find that counselling can be beneficial.
Joining a local support group can be a useful way to help you understand more about this condition.
Vitiligo itself does not develop into any other condition. However, other autoimmune disorders (diseases caused by the immune system) are slightly more common in people with vitiligo. For example, thyroid problems, diabetes and pernicious anaemia. Most people with vitiligo do not have these but your doctor may suggest a blood test to rule them out.
Some people with vitiligo are embarrassed about their condition. This can lead to low self-esteem and even depression. Some people find that counselling can be beneficial.
Joining a local support group can be a useful way to help you understand more about this condition.
