The color of your skin, hair, and eyes comes from a pigment called melanin, which is produced by cells called melanocytes. The skin disorder vitiligo, characterized by white patches of skin, happens when these melanocytes stop functioning.
“Vitiligo is a loss of pigment in the skin due to the destruction of pigment-forming cells called melanocytes,” says Michele S. Green, MD, a dermatologist with Lenox Hill Hospital in New York City.
The result is blotchy, uneven patches of white skin where the melanocytes have been destroyed. Vitiligo can affect not only your skin but your hair (including your eyebrows and eyelashes), the inside of your mouth and nose, and your retinas.
No one knows exactly what causes vitiligo, and there’s no cure for the skin condition either, but treatments are getting better. And the more we learn about the causes of vitiligo, the better treatments will become. Here’s what we know about vitiligo causes so far.
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Immune system issues
Scientists believe that autoimmunity plays a role in vitiligo. That’s when your immune system mistakenly identifies a part of your body—in this case the cells called melanocytes—as foreign and starts to attack them. People with other autoimmune diseases, specifically Hashimoto’s disease (which affects the thyroid gland) and alopecia (which makes hair fall out), are more likely to get vitiligo as well.
“Vitiligo is thought to be some autoimmunity resulting in damage and eventually killing of these cells,” says Henry W. Lim, MD, former chair of dermatology at Henry Ford Hospital in Detroit.
In particular, experts think that a type of vitiligo called nonsegmental vitiligo may be autoimmune-related. Nonsegmental vitiligo only damages the melanocytes on one side of your body.
So far, though, the links between vitiligo and other autoimmune disorders is just an association. We can’t say one causes the other. And treatment for another autoimmune disease usually doesn’t help vitiligo.
“We routinely check for thyroid function in people with vitiligo,” says Dr. Lim. “But treatment for Hashimoto’s would not affect the vitiligo.”
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Vitiligo can run in families, but it’s actually not as common as you might think. “In the vast majority of vitiligo cases, there is no family history,” says Dr. Lim, who is also past president of the American Academy of Dermatology. While many people wonder if vitiligo is hereditary, it’s not yet possible to predict if you’ll develop vitiligo based on family members with the condition.
Autoimmune diseases in general, however, seem to have a genetic component.
In some people, physical trauma or stress to the skin like a sunburn or exposure to industrial chemicals seems to trigger vitiligo, or at least precedes it.
Vitiligo can appear exactly on the sites where there has been some kind of injury. “Exactly why that is the case is not known,” Dr. Lim says.
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Like physical stress, psychological distress also seems to play a part in aggravating vitiligo, as is the case with many other skin conditions as well. Again, this relationship isn’t entirely understood.
What is known is that vitiligo, while not contagious or life-threatening, also causes significant emotional pain. “The effect is noticeable and quite disfiguring and, as you can well understand, it is psychologically very disturbing,” says Dr. Lim.
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Oxidative stress is an imbalance in certain types of compounds—free radicals and antioxidants—involved in different physiological processes. The imbalance can be caused by exposure to UV rays, pollutants, or other environmental factors. The areas of your body that are affected by vitiligo are known to be the most vulnerable to oxidative stress.
“We all get oxidative stress in our skin, but those with vitiligo are much more susceptible,” says Dr. Lim. “This has been the greatest advancement in our understanding of vitiligo. We have a much better understanding of the molecular pathways of vitiligo and why these cells get killed.”
This may pave the way for breakthroughs in treatment as scientists work on developing molecules that will block that pathway. “Significant improvements [in treatment] will be coming out in the next few years,” Dr. Lim says.
The skin condition vitiligo causes people to lose pigment in patches of skin in different areas of their body. In many cases, these light or white areas of skin are the only symptom of vitiligo.
“There’s a complete loss of pigment,” Henry W. Lim, MD, former chair of dermatology at Henry Ford Hospital in Detroit, tells Health. “In patients with fair skin, it’s not going to be all that noticeable, but with dark skin it’s very noticeable—and it can be quite bothersome.”
But vitiligo can affect more than just your skin. Other vitiligo symptoms include:
Premature whitening or graying of your hair, eyelashes, and eyebrows
Whitening on the inside of your mouth and nose
Lightening of the retina of your eye
The bleaching is caused by destruction of melanocytes, the cells that produce melanin, which is the pigment that gives your skin and hair its color. No one knows exactly why the cells stop working, but experts believe it’s often related to autoimmunity. That’s when your immune system turns on your body’s own tissue and starts destroying it.
Many people with vitiligo also have other autoimmune diseases, commonly autoimmune thyroid disease, says Daniel J. Aires, MD, director of dermatology at the University of Kansas Health System in Kansas City.
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Early on, the symptoms of vitiligo begin gradually. Areas affected by vitiligo “are lighter than the surrounding skin,” says Dr. Lim, who is also a past president of the American Academy of Dermatology, “and as time goes by, it will become white.” The lighter-colored patches start as small, round areas that grow into different and bigger sizes. The centers of the patches may be white with your normal skin color around them. The borders are sometimes smooth and sometimes ragged.
How fast vitiligo progresses (and which parts of the body it affects) is highly individual. Although vitiligo symptoms can appear on any part of the body, the white patches often start on areas that have been exposed to a lot of sun—aka your hands, feet, arms, face, and lips. But signs of vitiligo can also appear on your neck, elbows, armpits, knees, and even your genitals, and once the spots appear, they almost never go away.
Very occasionally, says Dr. Lim, some people may have another vitiligo symptom: itchiness.
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Vitiligo symptoms also vary depending on which type you have. There are two main kinds of vitiligo: segmental, which is limited or localized, and non-segmental, which is more widespread. “Vitiligo can cover a very small percentage of the body’s surface, or it can be widespread and affect multiple different regions,” says Dr. Aires.
Almost all cases of vitiligo are non-segmental vitiligo. Usually the symptoms appear symmetrically on both sides of your body. The arms, backs of hands, elbows, knees, feet, and areas around body openings (like the eyes) are frequent locations for non-segmental vitiligo signs. “It does have a predilection for the orofacial area—eyes, nose, around the mouth,” says Dr. Aires.
With segmental vitiligo, the light patches of skin only appear on one segment of your body. But even if the vitiligo only covers a small percentage of your skin, if it’s on your face or another visible area, it can be hugely distressing.
Rarely, people have a third type of vitiligo—universal or complete vitiligo—which affects the whole body.
No matter the type of vitiligo you have, the disease can be active (meaning it is still spreading or growing) or stable (meaning there’s been no change in the course of a year). If you’re noticing any signs and symptoms of vitiligo, it’s worth bringing it up with a doctor. “I personally think if you have a loss of pigment,” says Dr. Aires, “it’s not a bad idea to see a health care provider.”
There’s no cure for the skin condition vitiligo, which causes patches of skin—sometimes very large patches—to turn a lighter color. Given that this main symptom is so visible, many people get help from psychological interventions like cognitive behavioral therapy and tips for improving their self-esteem.
Vitiligo does not necessarily need to be treated. Many people turn to makeup to conceal the changes in their skin. Others fully embrace their light patches. But for those who do decide to pursue vitiligo treatment, there are medical options that sometimes stop the disease from spreading—and may even restore some pigment.
“The purpose of treatment is to stabilize the disease if it’s active,” Henry W. Lim, MD, former chair of dermatology at Henry Ford Hospital in Detroit, tells Health. “The next step is to bring the color back.”
In general, your face is the most responsive to vitiligo treatment, followed by your body, says Dr. Lim. Lips, nipples, and the tips of your toes and fingers are reluctant to respond to any treatment.
“The unfortunate thing is that for a fair number of patients, nothing works great,” Daniel J. Aires, MD, director of dermatology at the University of Kansas Health System in Kansas City, tells Health. “But there are many treatments, and they can be helpful for some patients.”
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One of the mainstays of vitiligo therapy is topical treatment, creams or ointments that go directly on the skin. Topical corticosteroids, for instance, can darken light patches of skin.
“Topical steroids can be very effective for local treatments, but there are still some potential side effects, particularly thinning of the skin,” says Dr. Aires. Blood vessels may show in areas where skin is already thin (like your face), and wrinkles may appear. You also shouldn’t use any type of steroids for long periods of time.
Tacrolimus (Protopic) and pimecrolimus (Elidel) are prescription topical medications in a class of drugs called calcineurin inhibitors that can also help treat vitiligo.
These usually don’t have side effects, says Dr. Lim, who is also past president of the American Academy of Dermatology. They work by stimulating your melanocytes (cells that make melanin) to produce pigment again. Although they’re more expensive than corticosteroids, they may also be more effective, especially if you use them in combination with light therapy (more on that below).
Some people get benefits from calcipotriene, a version of vitamin D. “The data is inconclusive” as to whether or not topical vitamin D will truly help people with vitiligo, Dr. Aires says. But it’s also not likely to hurt you and is “certainly something to consider,” he adds.
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Phototherapy or light therapy is the other long-standing mainstay of vitiligo treatment, especially vitiligo that’s more widespread. Phototherapy in the form of narrowband ultraviolet B (UVB) rays helps stimulate melanocytes to start producing pigment again. Sometimes the therapy is given with a drug called psoralens, which ramps up your sensitivity to light.
“You can expose the whole body or you can use targeted phototherapy, meaning using lasers to treat small areas of skin,” says Dr. Lim. “These are very safe treatments.”
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Oral corticosteroids may help slow vitiligo if it’s progressing quickly. Like other vitiligo treatments, it can be combined with UVB phototherapy.
“This is a bigger gun if the vitiligo is really widespread and very, very debilitating,” says Dr. Aires.
But there can be major downsides, especially if oral steroids are used for more than four or five months at a time. “There are potentially a lot of side effects, including weight gain, diabetes, and bone thinning—all kinds of things you’d really rather not have,” Dr. Aires says. “Certainly they can be used, but they’re something to think about very carefully.”
Generally, oral steroids aren’t effective for stable vitiligo, meaning vitiligo that is no longer spreading.
Surgery for vitiligo is a last resort, and only for people who’ve had stable disease for at least a year.
“There’s no reason to do this on people with active lesions because you’d be chasing after the disease,” Dr. Lim says. Also, “it’s not practical for very large surfaces.”
Surgery falls into two main categories. Skin-grafting is when you take skin from parts of the body that haven’t been affected by the disease and put them onto areas that have vitiligo.
Transplantation involves moving healthy melanocytes to areas of skin that have lost melanocytes and, therefore, pigment.
The surgery can sometimes cause side effects of its own, like scarring.