Vitiligo

Definition

Vitiligo is a skin condition in which there is loss of pigment (color) from areas of skin, resulting in irregular white patches that feel like normal skin.

Causes

Vitiligo appears to be an acquired condition and may appear at any age. There is an increased incidence in some families. Vitiligo is more noticeable in darker skinned people because of the contrast of white patches against dark skin.

The cause of vitiligo is unknown, but autoimmunity may be a factor. This condition affects about 1% of the U.S. population.

Lesions appear as flat areas with no pigment and with a darker boarder. The edges are sharply defined but irregular. Frequently affected areas are the face, elbows and knees, hands and feet, and genitalia.

Symptoms

• Sudden or gradual appearance of flat areas of normal-feeling skin with complete pigment loss

Exams 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:

• Exposure to intense ultraviolet light, such as narrow-band UVB therapy
• Oral medications, such as trimethylpsoralen (Trisoralen)
• Topical (on the skin) medications
  • Repigmenting agents such as methoxsalen (Oxsoralen)
  • Immunosuppressants such as pimecrolimus (Elidel) and tacrolimus (Protopic)
  • Corticosteroid creams

Skin may be grafted or removed from normal areas and placed into areas of pigment loss. In the future, skin pigment cells may be grown in the laboratory and used to treat areas of vitiligo.

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 de-pigmented. 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

• VitiligoSupport.com, www.vitiligosupport.com
• American Vitiligo Research Foundation,www.avrf.org
• National Vitiligo Foundation, www.nvfi.org

Outlook (Prognosis)

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

Possible Complications

Depigmented areas are more likely to sunburn or develop certain skin cancers. Vitiligo is associated with three systemic diseases: 1) pernicious anemia, 2) hyperthyroidism, and 3) Addison's disease.

When to Contact a Medical Professional

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

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