Vitiligo

Fair, dark, or any shade in between — most of us have skin that is generally the same color all over our bodies. But this isn't the case for people who have a condition called vitiligo.

What Is Vitiligo?

Vitiligo is a loss of skin pigment that causes white spots or patches to appear on the skin. No one knows exactly why this happens, but it affects people of all races, many of them kids and teens.

Because vitiligo affects a person's appearance, it can be upsetting. But it isn't medically dangerous. It's not a form of skin cancer. It's not an infection like MRSA. And it's definitely not contagious, so you can't catch it from someone else. In fact, most of the people who have vitiligo are every bit as healthy as everyone else.

What Happens?

To explain vitiligo, it helps to know a bit about how skin gets its color in the first place. Skin color is determined by cells called melanocytes. They produce a pigment called melanin, which gives skin its color and helps protect it from the sun.

Skin color is determined not by how many melanocytes someone has (we're all born with a similar amount), but rather by how active the cells are. Dark-skinned people have cells that naturally produce a lot of melanin, while light-skinned people produce much less.

Sometimes, the skin suddenly stops producing melanin. At first, this might cause a small spot, called a macule, that's lighter in color than the skin around it. In time these white patches may spread and grow to cover a larger portion of the body. Sometimes these white patches spread quickly at first and then remain stable for years. Other times the spread is slower, occurring over a longer period of time.

Although vitiligo affects people of all races equally, the spots tend to be more noticeable on darker skin.

Different Types of Vitiligo

There are three types of vitiligo, depending on how many patches someone has and where they are on the body: 

1. Focal vitiligo. A person has a few vitiligo spots in a single area.
2. Generalized vitiligo. A person has many vitiligo patches all over the body and they tend to affect the right and left sides of the body in a symmetrical pattern, like a mirror image. This is the most common type of vitiligo.
3. Segmental vitiligo. A person has vitiligo patches on one part or side of the body and usually nowhere else. This is the least common type of vitiligo.

Vitiligo can happen anywhere on the body, but it's more likely to develop in some areas:

• skin that's exposed to the sun, such as the face or hands
• skin that has folds, such as the elbows, knees, or groin
• skin around the eyes, nostrils, belly button, and genital areas

Because pigment cells give color to hair as well as skin, some teens with vitiligo may notice graying of the hair or a loss of color on the lips.

Possible Causes

Experts don't know exactly what causes vitiligo, but they do have theories. Some think it's an autoimmune_disorder and that the immune system is mistakenly attacking healthy melanocytes. Others think it's genetic.

Scientists do know that the risk of developing vitiligo increases in people with a family history of thyroid disease, diabetes, and certain conditions like alopecia (an autoimmune disease that causes hair loss).

Diagnosing Vitiligo

A dermatologist can usually tell if someone has vitiligo just by looking for the telltale white patches. On people with fair skin, a special tool called a Woods lamp might be used. This lamp uses ultraviolet light in a dark room to illuminate areas of damaged skin that would otherwise be hard to see with the naked eye.

Your doctor will ask about your medical history, and probably also ask you about:

• any skin conditions you or anyone in your family has had
• past immune problems you or anyone in your family has had
• any recent rashes or sunburns
• whether you've been ill or under stress recently

The doctor also may do a blood test to check for thyroid problems and diabetes, since they can increase the risk of vitiligo.

Very occasionally a doctor may perform a biopsy — removing a small piece of the affected area to check whether there are pigment cells in the skin. (The word biopsy might make you think of cancer, but in this case doctors aren't looking for cancer. People with vitiligo are at no greater risk of developing skin cancer than anyone else.) If the biopsy shows there are no pigment cells, this may confirm a case of vitiligo.

Treatment

There is no "cure" for vitiligo. Sometimes patches go away on their own. But when that doesn't happen, doctors can prescribe treatments that might help even out skin tone. Some of these treatments are things you can try at home; others are done by a doctor.

People and conditions are very different, so what works for one person may not work for another. And no vitiligo treatment is likely to be 100% effective at making the spots disappear altogether.

Home Care

• Sunscreen. Use a good sunscreen every day. Because vitiligo spots have no melanin, they can't tan. If the skin isn't protected with sunscreen, vitiligo patches may burn or scar. Getting a tan on the rest of your body will only highlight the white patches, especially if you have light skin.
• Cosmetics. Many different kinds of concealers are available, both over-the-counter and through a dermatologist. Ask your doctor for recommendations and try different brands until you find the one that works best for you.

Medical Treatment

Some of the more common medical treatments for vitiligo include:

• Corticosteroid creams. When applied to white patches very early in the disease, corticosteroids may help to bring some color back to the skin by decreasing the inflammation that leads the skin to have fewer pigment cells. Don't let the word "steroids" put you off. Corticosteroids are medications, not the type of anabolic steroids that athletes use.
• Photochemotherapy (also known as PUVA). PUVA therapy has two steps: first, a medication called psoralen is either applied to the white patches of skin or taken orally; then, the skin is exposed to ultraviolet light, sometimes from the sun but more often from an artificial source like a UVA lamp. This turns the affected skin pink, which in time tends to fade to a more natural (often slightly darker) color. You'll want to ask your doc about side effects of PUVA treatment — including a possibility of severe sunburn and skin blistering.
• Narrow-band ultraviolet B (UVB) therapy. This treatment is more widely used than PUVA. It's similar, except that the ultraviolet light used is UVB instead of UVA. UVB treatment doesn't require psoralen, eliminating some of the risk associated with PUVA.

Researchers are looking into a new procedure called a melanocyte transplant. It works by removing a sample of normally pigmented skin and using it to grow new melanocytes in the lab. These can then be transplanted back into the depigmented skin to return some of the missing color.

Living With Vitiligo

Vitiligo isn't dangerous to your physical health. But it can still feel like a big deal if you're concerned about your appearance.

It's normal to feel like you want to cover up vitiligo, and you need to do what makes you most comfortable. But if you're starting to turn down every pool party or beach invitation, it's a signal to take back your life. If people ask about your skin, go ahead and explain — if you want to. It can help to know you're not alone. Even pop star Michael Jackson is said to have struggled with vitiligo.

In the end, if people still don't seem to get it, that's their problem, not yours. If you're feeling upset, get support from people you trust, whether that's a family member, friend, teacher, counselor, or support group. There are plenty of people who love you just the way you are.

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