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Vitiligo Facts: Skin Pigment Loss and Possible Treatments

Linda Crampton is a writer and teacher with a first-class honors degree in biology. She often writes about the scientific basis of disease.

What Is Vitiligo?

Vitiligo is a skin disorder in which cells called melanocytes are destroyed. The cells make melanin, the brown pigment that colors our skin. Without melanocytes, pigment can't be made. People with vitiligo often have irregularly-shaped patches of depigmented skin. The patches frequently enlarge over time and produce a mottled appearance.

I've had vitiligo patches on my hands and forearms for several years. Since I have pale skin, the white areas are most noticeable in summer when the rest of my skin tans. At other times of the year, the pigment loss is not a big problem. For people with darker skin or for people who have lost pigment in a more visible place, such as the face, the disorder may be much more problematic. The darker the skin, the more obvious the contrast between light patches and pigmented areas.

The cause of the melanocyte destruction in vitiligo isn't known for certain, but most researchers think that it arises due to an autoimmune problem. Our immune system normally destroys bacteria and viruses. In an autoimmune disease, the system mistakenly attacks the body's own cells.

Pigment loss on my right arm and hand

Pigment loss on my right arm and hand

Types of Vitiligo

The classification of vitiligo varies. Today most dermatologists recognize two types—non-segmental and segmental. The non-segmental version is by far the most common type. According to the American Academy of Dermatology, the following features are the main characteristics of the condition.

  • Depigmented patches appear on both sides of the body. They may have different shapes, however.
  • The loss of pigment often begins on the hands, wrists, or feet or around the eyes or mouth.
  • Depigmented patches often grow in size once they form.
  • Loss of pigment may proceed for a while, then pause, and then start again. This start-and-stop cycle may occur repeatedly.

Segmental vitiligo develops in one part of the body and usually starts at an early age. Pigment loss often stops at a certain point and doesn't restart. The condition is frequently accompanied by a loss of hair color.

I have non-segmental vitiligo. The depigmentation is slowly spreading over my hands and forearms and has also appeared on my legs. In some people, the pigment loss is located in other or additional areas and the condition progresses more rapidly.

Melanocytes are cells that make melanin. Some of the cells are destroyed in vitiligo.

Melanocytes are cells that make melanin. Some of the cells are destroyed in vitiligo.

Possible Symptoms of the Disorder

Depigmentation tends to first develop as small spots on areas exposed to sunlight, especially the face, lips, arms, and hands. It may be particularly noticeable around openings in the skin, such as the lips and the eyes. The spots may enlarge over time. New spots sometimes develop in areas that aren't normally exposed to the sun. The depigmented patches may be paler than the surrounding skin or may be completely white. The patches are flat and feel normal to the touch. They also have normal sensation.

Some people with vitiligo develop grey hair, eyelashes, eyebrows, and facial hair at a relatively young age (before 35). There may be pigment loss inside the mouth. Pigment is sometimes lost from the retina, the light-sensitive layer at the back of each eyeball, although this seems to be a very rare process.

Possible Causes of Vitiligo

Vitiligo affects both genders and all ethnic groups equally. It usually appears before the age of forty. About 1% to 2% of the world's population have the disorder. People with vitiligo are often healthy, apart from their depigmented skin patches. Some have a previously diagnosed autoimmune disease, however.

The most widely accepted theory for the origin of vitiligo is that it arises due to an autoimmune problem in which the immune system destroys melanocytes. People with the condition may have an additional autoimmune disorder, such as hyperthyroidism, a condition in which the thyroid gland is overactive, alopecia areata, a disorder in which hair is lost, or pernicious anemia, a disease in which the intestine cannot absorb enough vitamin B12 from food.

Another theory for the origin of vitiligo is that it's caused by a stressful event, such as a severe sunburn to the area that develops white spots, exposure to a chemical toxin from outside or inside the body, or serious psychological stress. There is much less support for this idea than the theory that the disorder is an autoimmune condition, however.

There seems to be an inherited component in some forms of vitiligo, since it sometimes runs in families. Specific genes are believed to make a person susceptible to loss of skin pigment.

Depigmented areas on my left hand and forearm

Depigmented areas on my left hand and forearm

Effects That People May Experience

Vitiligo is physically painless but may cause a lot of emotional turmoil. People with the disorder may be very self conscious about their appearance. For some people, the appearance of depigmented patches is a life-changing event. It may be an especially difficult condition for those with darker skin because the depigmented areas may be very obvious. The pigment loss may cause people to feel that they are losing their identity. In addition, people may be treated badly because of their appearance.

There is another way in which vitiligo may affect someone in addition to being embarrassing, depressing, or isolating. Melanin in skin gives us some protection from ultraviolet light in sunlight. Since depigmented patches lack melanin, it's extremely important that a person covers them with sunscreen to help prevent a sunburn and skin cancer.

Possible Treatments

There is no cure for vitiligo, but techniques that may improve the appearance of the skin exist. Very occasionally, pigment returns to pale areas without any treatment. If the pigment doesn't return, a person will either need to choose a treatment for the disorder or decide to receive no treatment for the condition if they prefer.

Possible ways of dealing with the condition include covering the light areas with clothing, makeup, or camouflage creams, using techniques to encourage pigment to reappear, or removing the remaining pigment from the skin so that all of the skin has the same color.

The possible treatments should be discussed with a doctor. This is especially important in the case of ones that are designed to stimulate pigment reappearance or to remove pigment, since these may have serious side effects. Another factor to consider is that while vitiligo treatments may eliminate white spots, more depigmented patches may appear in the future. This means that a treatment may need to be repeated.

Vitiligo and poliosis (loss of pigment from hair)

Vitiligo and poliosis (loss of pigment from hair)

Disguising Depigmented Skin Patches

The easiest and safest method to disguise vitiligo patches is to cover them with clothing. This isn't always possible or practical, however, so other strategies may be necessary.

If a suntan is avoided, light patches may not be very noticeable in people with pale skin. This is true for me. My skin was tanned in the photos of my hand and arm in this article, so the depigmented areas showed up. The problem is much harder to see when I'm not tanned, especially under some lighting conditions. I've been much more careful about avoiding a tan since I took the photos. This is mainly because a tan indicates that sunlight has affected my skin and that the pigment-free areas of the skin may have been damaged by the light.

Many people with vitiligo find it harder to disguise their condition than I do. Makeup can cover and hide light patches and may be sufficient to disguise some cases of the disorder. Another option is the use of camouflage creams, which come in a range of colors. They're often waterproof and stay on the skin for a long time. Stains and self-tanning products may also be effective. The safety of all products applied to the skin should be investigated before they're used.

Getting a perfect match between the appearance of pigmented and unpigmented skin with makeup or a related product may take practice and be time consuming, but the effort could be very worthwhile for some people.

Corticosteroid and Immunomodulator Creams

One type of treatment for restoring pigment that may be prescribed is the use of a topical corticosteroid cream. A "topical" cream is one that is used on the skin. A corticosteroid cream may encourage pigment to reappear, although several months of treatment may be needed in order for the cream to work. The cream does have side effects. It may cause the skin to become thinner and may also cause skin striae to appear. Striae are irregular areas of skin that look like stripes or lines. They're sometimes known as stretch marks.

A prescribed immunomodulator cream may also restore pigment. This cream can suppress the action of the immune system in the skin. It may work where corticosteroids aren't tolerated. Modifying the activity of the immune system can sometimes be a risky activity, so a doctor's instructions should be followed carefully.

People who have lost skin pigment need to be careful when exposed to sunlight.

People who have lost skin pigment need to be careful when exposed to sunlight.

PUVA Therapy

Psoralen photochemotherapy, or PUVA, is a process used to treat a variety of skin diseases. PUVA stands for psoralen ultraviolet A. Psoralen is a chemical. UVA rays have a wavelength between 320 nm and 400 nm.

PUVA requires the administration of psoralen before the use of ultraviolet light. The chemical is administered by mouth, as a cream rubbed on the skin, or by immersion in a liquid containing the chemical. Psoralen makes the skin more sensitive to UVA rays. After the psoralen treatment, the patient is exposed to the light. The skin turns pink at first and then the pink color is replaced by normal skin pigment, if all goes according to plan.

There is a serious concern associated with PUVA treatment. Shining ultraviolet light on skin increases the risk of skin cancer, just as it does when we are exposed to sunlight without wearing sunscreen. Multiple PUVA treatments increase the risk of cancer development. There's also a risk that the treatment will cause too much pigment to appear, or hyperpigmentation, resulting in darker than normal areas on the skin. These dark patches may be temporary, however.

Psoralen treatment may increase to susceptibility to sunburn, so it's important to limit exposure to the sun after a treatment and to wear sunglasses. Another problem is that ingesting psoralen can cause unpleasant side effects, such as stomach upset and nausea.

Narrowband UVB Light

Narrowband UVB light is also used to restore pigment lost in vitiligo and seems to be increasing in popularity. This light has two major differences from PUVA treatment: it doesn't require a psoralen pre-treatment and it uses a narrow range of ultraviolet wavelengths in the UVB range. The UVB light is provided by light panels or by light cabinets, which are available in home versions. A doctor's guidance is needed if treatment is performed at home.

Other Possible Treatments

There is another option for some people with many large vitiligo patches. The remaining pigment can be removed from the skin by a chemical or a laser, allowing the skin to look the same color everywhere. If this treatment is performed, a person's whole skin surface is very susceptible to sun damage. Other possible treatments include a different type of laser treatment to stimulate repigmentation and the application of skin grafts. Specific vitamin supplements may also help, although this is not yet proven. It's important to note that ingesting an excessive amount of vitamin supplements can be dangerous. A doctor's instructions should be followed in regards to safety.

New techniques that may help vitiligo sufferers are available in some places. One of these is a melanocyte transfer. In this technique, melanocytes are obtained from a person's pigmented skin and allowed to multiply in a laboratory dish. The melanocytes are then transplanted into the patient's depigmented areas.

Many vitiligo treatments need to be used for months to see an effect. Certain treatments may help some people but not others. The good news is that there is an increasing range of treatments that a doctor can prescribe. In addition, research into the nature of the disorder is continuing and new discoveries are being made.

The latest discoveries support the idea that vitiligo is an autoimmune condition. Hopefully, in the near future doctors will be able to treat the cause (or causes) of the disorder as well as its symptoms.

Coping With the Disorder

Some people are trying to remove the stigma that is often attached to pigment loss. Chantelle Brown-Young, also known as Winnie Harlow and Chantelle Winnie, is a Canadian model with prominent depigmented patches that she doesn't attempt to hide. She's becoming successful in her career and is raising awareness of vitiligo and the problems that it causes. She's shown in the video above.

Humans have a wide range of skin colors, which add variety to life. It would be nice if a mixture of darker and lighter skin areas on a person's body was as acceptable to the general public as a monotone skin, but it often isn't. The situation may be improving in some places as public figures such as Winnie Harlow show their loss of pigment, however.

For some people, the effort needed to cover depigmented areas with makeup is very worthwhile. For them, revealing their vitiligo may be unthinkable due to their embarrassment or to the way in which they are treated. Other people remain confident and do nothing about their light patches, even when these are obvious. Some even embrace the patches as part of their identity and aren't disturbed by any unwanted attention. Every person with vitiligo needs to decide on their own approach to the disorder.

Research and Support

If you're considering getting a treatment for vitiligo, do some research about the treatment and write some questions down to ask your doctor. If you do research on the Internet, make sure that you visit authoritative sites such as vitiligo associations and government health sites. Many websites claim that they have a wonderful "cure" for the disorder, but their products are generally not clinically tested and may be completely useless or even harmful.

If you need support dealing with the disorder, your family and friends may be a great help. A vitiligo group in your area would most likely be a wonderful resource too, but there may not be one available. Meetings with an individual counselor can also be helpful. In addition, the last two sites mentioned below may be useful. Make sure that you visit one or more of these support sources if you need them. You don't have to deal with vitiligo on your own.

References and Resources

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

Question: I am an 83-year-old female of mixed heritage—Anglo, Hispanic, and Filipino. I've noticed areas on my legs that seem to be losing pigmentation. It isn't very noticeable, but seems more obvious during summer when my skin darkens. At one time, I had very prominent discoloration on my face. I still try to stay out of direct sunlight, but it is difficult as I live in Bakersfield, California, where the sun shines practically year-round. Do you have any suggestions?

Answer: I suggest that you make sure that the areas that have lost pigment are protected from sunlight when you go outdoors. Suitable clothing or sunscreen is important. It would be a good idea to visit your doctor to get other suggestions for taking care of the areas of your skin where pigment has been lost and—if you don't already know this—to find out whether you actually have vitiligo instead of another condition.

Question: Can vitiligo on the scalp cause hair loss?

Answer: There isn’t a link between vitiligo on the scalp and hair loss, as far as researchers know. The condition can cause patches of skin and hair to turn white, but it doesn’t cause the loss of hair. It’s believed to be an autoimmune condition.

Alopecia areata is a condition in which there are patches of hair loss on the scalp and sometimes on the body. Like vitiligo, it’s believed to an autoimmune condition. It’s possible for a person to have more than one autoimmune condition at the same time, so some people have both vitiligo and alopecia areata. The conditions are separate disorders, however. Just because a person has one of them doesn’t mean that they are bound to get the other.

© 2012 Linda Crampton

Comments

Linda Crampton (author) from British Columbia, Canada on March 13, 2019:

Thanks for the comment, Sreelesh. I hope your wife’s brother-in-law eventually finds a treatment that helps him.

Sreelesh Kumar from Kunjathur, Manjeshwar, Kasaragod, Kerala, India on March 13, 2019:

Informative article. One of my wife's brother-in-laws still has this problem and it is not cured even after continuous treatments.

Linda Crampton (author) from British Columbia, Canada on November 23, 2015:

Thanks for commenting and for sharing the information, Peg. I hope things improve for your friend.

Peg Cole from Northeast of Dallas, Texas on November 23, 2015:

Very interesting explanation of the causes and treatment options for Vitiligo. A friend of mine has this condition and is very self conscious as he is a musical performer and teacher whose duties require him to be in the limelight quite a bit. He is trying the PUVA treatment and wears long sleeves even in the heat of the summer.

Linda Crampton (author) from British Columbia, Canada on January 28, 2015:

Thank you very much.

Cure For Vitiligo on January 28, 2015:

It's actually a great and useful piece of information. I'm happy that you just shared this helpful information about Vitiligo.

Linda Crampton (author) from British Columbia, Canada on January 23, 2013:

Thanks for the visit and comment, MPG Narratives, and thank you for sharing your experience. Yes, vitiligo is often harder to deal with when a person has darker skin. Some people take it in stride, though!

Maria Giunta from Sydney, Australia on January 23, 2013:

Thank you for writing a very thorough article on vitiligo, I too have this skin condition. Many people ask me what is 'wrong with my skin' but like you I am lucky to have pale skin and it doesn't bother me that much. I do understand though how some people would be psychologically scarred, especially those with darker skin.

Linda Crampton (author) from British Columbia, Canada on October 12, 2012:

Thank you for the visit and the comment, Ingenira. It's important that people know that vitiligo isn't infectious!

Ingenira on October 12, 2012:

Excellent writeup on vitiligo. A lot of people are not aware of how non-infectious is this skin disorder. It is good that you share it here, so that more people are aware of it and will not keep a distance from the people with this disorder.

Linda Crampton (author) from British Columbia, Canada on September 22, 2012:

Hi, Lipnancy. Your comment is very interesting. It's interesting to think about the possible cause or causes of vitiligo and autoimmune diseases too. That's a strange coincidence that you had two different neighbors with vitiligo - or maybe the disorder is more common than researchers realize!

Nancy Yager from Hamburg, New York on September 22, 2012:

Believe it or not, I had two different neighbors with this. I am just wondering about the connection between traumatic events and auto-immune deficiency diseases. I noticed this connection myself when I worked with persons with disabilities.

Linda Crampton (author) from British Columbia, Canada on September 21, 2012:

Thank you very much for the comment, the votes and the share, Denise! It's interesting to hear from another person with vitiligo. Up to now I've haven't been bothered by mine, but while trying to get accurate photos for this hub I noticed that it's spread more than I thought. I also have a small spot on the lower part of my neck that's been unchanged for a couple of years. I hope it stays that way!

Denise Handlon from North Carolina on September 21, 2012:

Outstanding information and education on this subject, Alicia. Thanks for sharing this and your experience with it. Gee, I learned more from reading / watching the excellent videos here than I did from the dermatologist I went to see. I have this condition, generalized, on both hands along the thumbs. I have an additional patch on my left inner thigh. It is strange to have it, and was disturbed by the presence of it in a visible place, but I'm used to it now. I've had it for about 10 yrs now.

Rated up and U / I Sharing.

Linda Crampton (author) from British Columbia, Canada on September 21, 2012:

Thank you for the vote and the comment, teaches. Vitiligo is often a misunderstood condition. I've certainly learned more about it since I developed the disorder!

Dianna Mendez on September 21, 2012:

I have seen some people with this condition. I always thought it was a burn or something that they had causing the discoloration. Great sharing and information on this disorder. Voted up.

Linda Crampton (author) from British Columbia, Canada on September 21, 2012:

Thanks for the visit and the comment, b. Malin. Yes, it is sad that at the moment doctors can only treat the symptoms of vitiligo. We really need to treat the cause of the disorder, but this isn't possible at the moment since the cause isn't known for certain.

b. Malin on September 21, 2012:

Hi Alicia,

Sad to read about this Condition, especially since there is really no cure. As usual you've done an Excellent job of Researching and Informing us. Thanks for the Educational read.

Linda Crampton (author) from British Columbia, Canada on September 21, 2012:

Thank you very much for the comment, GoodLady! Autoimmune disorders are very unpleasant - and annoying, too. Our immune system is supposed to help us, not hurt us! I hope that researchers find the reasons for these disorders soon, and that they find a way to turn off the attack by the immune system.

I hope very much that you continue to stay healthy, or as healthy as you can be with your thyroid problem, GoodLady.

Penelope Hart from Rome, Italy on September 21, 2012:

Such thorough explanations which must be very helpful to people who have this condition, or those near to them. That immune system is such a nuisance and responsible for so very many disorders. I have Hashimoto's which is a serious complication since I had cancer (with a high rate of recurrence). My sisters all have an autoimmune disorder, though the skin hasn't been the problem, yet.

You write so beautifully.

Linda Crampton (author) from British Columbia, Canada on September 20, 2012:

Thank you, unknown spy. I appreciate your visit and comment.

Life Under Construction from Neverland on September 20, 2012:

I saw one girl with this condition and its on her face.. Very well presented hub with lots of info that easily understandable.

Linda Crampton (author) from British Columbia, Canada on September 20, 2012:

Hi, Tom. Thanks for the visit, and thanks for the comment and the votes as well!

Thomas Silvia from Massachusetts on September 20, 2012:

Hi my friend, great well written hub with all good information about vitiligo and how to cope with it . Well done !

Vote up and more !!!

Linda Crampton (author) from British Columbia, Canada on September 20, 2012:

Thank you very much, drbj. I hope that a cure is found soon. Right now we're just treating the symptoms. Sometimes these treatments are effective, but sometimes they're not. In addition, a treatment may be effective for a while - even for months or years - and then new white patches appear.

Linda Crampton (author) from British Columbia, Canada on September 20, 2012:

Thank you very much for the visit and the comment, CMHypno. Vitiligo can certainly be difficult to live with for many people. Even though it's not a dangerous disease physically (except for the risk of sun damage to the skin) it may be very serious psychologically.

drbj and sherry from south Florida on September 20, 2012:

Hi, Alicia. This is very thorough, very informative and well-researched. Those individuals with severe vitiligo often suffer psychological as well as emotional stress. Perhaps one day a cure will be found.

CMHypno from Other Side of the Sun on September 20, 2012:

Skin conditions are often very difficult to live with, so thank you for all this really great information on vitiligo Alicia.

Linda Crampton (author) from British Columbia, Canada on September 20, 2012:

Thank you very much for the comment, the vote and the share, mary! I appreciate your visit. Yes, reportedly Michael Jackson had vitiligo. Some people may think that the loss of skin pigment isn't serious, but as you say it can be very difficult to live with when it's widespread or very noticeable. For some people vitiligo is psychologically devastating.

Mary Hyatt from Florida on September 20, 2012:

This would be a difficult condition to live with if it were all over the face and body. Isn't this what Michael Jackson had? You did a lot of research on this Hub.

I voted this UP, and will share.

Linda Crampton (author) from British Columbia, Canada on September 19, 2012:

Thank you for the comment and the vote, ananceleste. I'm so glad that your sister has accepted her condition. It's difficult for some people to deal with the problem. I hope there are major advances in our understanding of vitiligo very soon.

Anan Celeste from California on September 19, 2012:

Great hub! My baby sister ( she is 18) has this condition. She is very self conscious about her patches. But has learned to accept it. It would make me cry sometimes. Voted up!