Vitiligo

• Causes, incidence, and risk factors

  Vitiligo appears to be an acquired condition and may appear at any age. There is an increased rate of the condition in some families.

  The cause of vitiligo is unknown, but autoimmunity may be a factor. Vitiligo is associated with three systemic diseases:

  • Pernicious anemia
  • Hyperthyroidism
  • Addison's disease

  The condition affects about 1% of the United States population.

• Symptoms

  Vitiligo is more noticeable in darker skinned people because of the contrast of white patches against dark skin.

  There is a sudden or gradual appearance of flat areas of normal-feeling skin with complete pigment loss. Lesions appear as flat areas with no pigment and with a darker border. The edges are sharply defined but irregular.

  Frequently affected areas are the face, elbows and knees, hands and feet, and genitalia.

• Signs and tests

  Examination is usually sufficient to confirm the diagnosis. In some cases, a skin biopsy may be needed to rule out other causes of pigment loss. Your doctor may also perform blood tests to check the levels of thyroid or other hormones, and vitamin B12 levels.

• Treatment

  Vitiligo is difficult to treat. Early treatment options include the following:

  • Light therapy (exposure to controlled intense ultraviolet light in a doctor's office or hospital)
  • Medicines taken by mouth such as trimethylpsoralen (Trisoralen)
  • Medicines applied to the skin such as:
    • Corticosteroid creams
    • Immunosuppressants such as pimecrolimus (Elidel) and tacrolimus (Protopic)
    • Repigmenting agents such as methoxsalen (Oxsoralen)

  Skin may be grafted or removed from normal areas and placed onto areas of pigment loss.

  Several manufacturers produce cover-up makeup or skin dyes to mask vitiligo. Ask your health care provider for the names of these companies.

  In extreme cases when most of the body is affected, the remaining pigmented skin may be depigmented. This is a permanent change and is a last resort.

  It is important to remember that skin without pigment is extremely susceptible to the sun's damaging effects. Be sure to apply a high-SPF sunblock and use appropriate safeguards against sun exposure.

• Support Groups
  • American Vitiligo Research Foundation -- www.avrf.org
  • National Vitiligo Foundation -- www.nvfi.org
  • VitiligoSupport.com -- www.vitiligosupport.org
• Expectations (prognosis)

  The course of vitiligo varies. Some areas may regain pigmentation (coloring), but other new areas may appear. Loss of pigment may be progressive.

• Complications

  Depigmented areas are more likely to sunburn or develop certain skin cancers.

• Calling your health care provider

  Call for an appointment with your health care provider if you develop areas of skin that lose their coloring.

Review Date: 7/11/2008

Reviewed By: Michael Lehrer, M.D., Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.