Patient education: Vitiligo (The Basics)

What is vitiligo? — Vitiligo is a condition that causes patches of skin (and sometimes hair) to turn white or lose its color. Doctors are not sure what causes vitiligo, but they suspect 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 that turns white or loses its color. But which areas of skin are affected depends on the type of vitiligo a person has.

There are a few different types 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 might affect only the left or the right side of the body in splotches (picture 3).

Should I see a doctor or nurse? — Yes, if you develop patches of white skin, see a doctor or nurse.

Will I need tests? — Maybe. Vitiligo often happens along with other autoimmune problems, so your doctor or nurse might order blood tests to check for those other problems.

How is vitiligo treated? — Treatments help return normal color to the skin. The options include:

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

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

●Light therapy – During light therapy, your skin is exposed to a special kind of light called "ultraviolet light" (also called "UV" light). This therapy is usually done in a doctor's office. Depending on the type of light therapy you have, you might take a medicine capsule before you have the therapy.

Is there anything I can do on my own? — Yes. Do your best to avoid getting a sunburn or suntan. Otherwise the spots of skin that lack color will look even more different from your healthy skin. To protect yourself from the sun:

●Stay out of the sun in the middle of the day (from 10 AM to 4 PM), when the sun's light is strongest

●Stay under a sun umbrella, tree, or other shady spot

●Wear sunscreen – Put sunscreen on all parts of your body that are not covered by clothes. Then reapply sunscreen every 2 to 3 hours, or after you sweat or swim. It's important to choose a sunscreen that:

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

•Protects against 2 types of UV light, called "UVA" and "UVB" – Sunscreens that offer both UVA and UVB protection are sometimes called "broad spectrum."

•Has not expired or is not more than 3 years old

●Wear a wide-brimmed hat, long-sleeved shirt, and long pants

●Do not use tanning beds

If you are bothered by the way your skin looks, you can use special cosmetic products to make the skin changes less obvious. Examples are sold under the brand names Dermablend and Covermark. Other products can also be helpful.

What if I want to get pregnant? — If you want to get pregnant, you should stop any medicines you use for vitiligo. If you use light therapy without medicines, that is still OK to do. Do not start medicines for vitiligo again until after you have your baby and are done breastfeeding.

What will my life be like? — In some people, vitiligo goes away on its own. But in most people, the condition gets slowly worse, affecting more and more skin. If you are bothered or worried about how you look, speak to your doctor or nurse. You might also want to look into connecting with other people with vitiligo or joining a support group. To find information on vitiligo support groups, visit:

●Vitiligo Support International – www.vitiligosupport.org

●American Vitiligo Research Foundation – www.avrf.org