Patient education: Vitiligo (The Basics)

What is vitiligo? — 

This is a condition that causes patches of skin (and sometimes hair) to turn white. Doctors are not sure what causes it. But many think it is caused by an autoimmune response. That is when the body's infection-fighting system, called the "immune system," attacks healthy cells. In this case, the affected cells are the ones that give skin its color.

What are the symptoms of vitiligo? — 

The main symptom is skin turning white.

The areas of skin that are affected depend on the type of vitiligo. The most common type is called "generalized vitiligo" or "vitiligo vulgaris." But there are others, including "acrofacial vitiligo" and "segmental vitiligo."

Generalized vitiligo usually affects both the left and right sides of the body the same way (symmetrically). It tends to affect:

●Fingers, toes, ears, legs, or other body parts that are far from the center of the body (picture 1)

●Skin surrounding openings in the body, such as the mouth, eyes, and nose

●Stretchy parts of skin, such as the skin covering the elbows, knees, or finger joints

●Parts of skin that are injured or get rubbed a lot, such as the skin under shoulder straps, waistbands, and collar areas

Acrofacial vitiligo affects only the:

●Fingers, toes, ears, or other body parts that are far from the center of the body (picture 2)

●Skin surrounding openings in the body, such as the mouth, eyes, and nose

Segmental vitiligo only affects the left or the right side of the body (picture 3).

Will I need tests? — 

Maybe. Doctors can usually tell if a person has vitiligo by looking at their skin. Sometimes, they will use a special lamp. They might do tests to confirm whether you have vitiligo or another skin problem.

Vitiligo often happens along with other autoimmune problems. Your doctor or nurse might order blood tests to check for those other problems.

How is vitiligo treated? — 

Treatments help return the skin to its normal color. The options include:

●Steroid medicines – These come as ointments, creams, or gels. Examples include fluticasone (brand name: Cutivate) or mometasone (brand name: Elocon).

●Calcineurin inhibitors – These come as ointments or creams. Examples include pimecrolimus (brand name: Elidel) and tacrolimus (brand name: Protopic).

●JAK inhibitors – These come as creams. An example is ruxolitinib (brand name: Opzelura).

●Light therapy – Your skin is exposed to a special kind of light called "ultraviolet light" ("UV light"). This is usually done in a doctor's office. The most common type of light therapy is called "narrowband ultraviolet B phototherapy" ("NBUVB"). You might need to take a medicine by mouth before the therapy.

What can I do on my own? — 

Try to avoid getting a sunburn or suntan. This is because the spots of skin without color can get sunburned more easily than the rest of your skin. This can make the white patches spread.

To protect yourself from the sun:

●Stay out of the sun in the middle of the day (from 10 AM to 4 PM). In the US, this is when the sun is usually strongest.

●Stay in the shade, like under an umbrella or tree.

●Wear sunscreen – Put sunscreen on all parts of your body that are not covered by clothes. Reapply sunscreen at least every 2 hours, or after you sweat or swim. It's important to choose a sunscreen that is:

•SPF of 30 or greater – SPF is a number that tells you how well the sunscreen protects the skin from harmful kinds of UV light.

•"Broad spectrum" – There are 2 kinds of UV light: UVA and UVB. A broad-spectrum sunscreen protects you against both.

•Water resistant – Sunscreens that are "water resistant" or "very water resistant" last for 40 to 80 minutes of swimming or sweating.

•Not expired, or not more than 3 years old – Expired or old sunscreen does not work as well.

●Wear clothing that protects you from the sun – This can include:

•A wide-brimmed hat, long-sleeved shirt, and long pants

•Clothes that are dark and have tightly woven fabric

•Certain kinds of fabric, such as cotton and polyester

•Clothes that are designed for sun protection – "UPF" is a number that tells you how well a piece of clothing protects the skin from UV light. If you want to buy clothing made to protect you from the sun, look for clothes with a UPF of 15 or higher.

●Do not use tanning beds.

If you are bothered by how your skin looks, you can use special cosmetic products to make the skin changes less obvious. Examples are Dermablend and Covermark. Other products can also help.

What if I want to get pregnant? — 

Talk with your doctor. Some medicines used to treat vitiligo should not be used during pregnancy or breastfeeding. You can still get light therapy without medicines if you are pregnant or breastfeeding.

What will my life be like? — 

Vitiligo sometimes goes away on its own. But usually, the condition gets slowly worse, affecting more and more skin. If you are bothered or worried about how you look, talk to your doctor or nurse. You might also want to connect with other people with vitiligo or join a support group. These websites have information on vitiligo support groups:

●Vitiligo Support International – www.vitiligosupport.org

●American Vitiligo Research Foundation – www.avrf.org

When should I call the doctor? — 

Call your doctor or nurse if you have not been diagnosed with vitiligo and develop patches of skin that look white or lighter than usual.

More on this topic

Patient education: Phototherapy (The Basics)
Patient education: Staying safe in the sun (The Basics)
Patient education: Sunburn (The Basics)

Patient education: Sunburn prevention (Beyond the Basics)
Patient education: Sunburn (Beyond the Basics)