Vitiligo

What Is Vitiligo?

Vitiligo (vih-tih-LY-go) is a loss of skin pigment, or color, that causes white spots or patches on the skin.

While vitiligo might make kids self-conscious, this skin condition is not medically dangerous. It's not a form of skin cancer, it's not an infection like MRSA, and it's not contagious. In fact, most kids who have it are every bit as healthy as everyone else.

What Happens in Vitiligo?

Most of us have skin that is generally the same color all over our body. But this isn't the case for those with vitiligo. This skin disorder affects the melanocytes (meh-LAN-uh-sites). These are cells deep within the epidermis (the outer layer of the skin) that make melanin. Melanin (MEL-eh-nen) is the pigment that gives skin its color and helps protect it from the sun.

Our skin color is not based on how many melanocytes we have (we're all born with a similar amount), but by how active they are. Dark-skinned people have cells that naturally produce a lot of melanin, while the cells in light-skinned people make much less.

Sometimes, though, skin cells suddenly stop making melanin. At first, this might cause a spot — called a macule — whose color is much lighter than the skin around it. But in time, these light patches can spread and grow to cover a larger part of the body. Sometimes the spread happens quickly, and then remains stable for a number of years. Other times it happens slowly, over a longer period of time.

What Are the Types of Vitiligo?

Dermatologists label the types of vitiligo based on the amount of the patches and where they are:

• focal vitiligo happens when there are just a few spots in a single area
• generalized vitiligo is associated with many spots all over the body. These tend to be symmetrical, meaning they affect the right and left sides of the body like a mirror image. This is the most common form of the condition.
• segmental vitiligo is characterized by spots only on one side of the body and usually nowhere else. This type of vitiligo is not common.

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

• areas that are exposed to the sun, such as the face or hands
• skin that has folds, such as the elbows, knees, or groin
• skin around orifices (body openings), such as the eyes, nostrils, belly button, and genital area

Although kids of all races are affected equally, spots tend to be more visible on those with darker skin.

Sometimes kids with vitiligo have other symptoms, such as premature graying of the hair or a loss of pigment on the lips, since pigment cells are found in these places too.

What Causes Vitiligo?

No one knows exactly why vitiligo happens, but it affects people of both sexes and all races. Many people with the condition are kids and teens. Theories vary on what causes vitiligo. Some experts think it is an autoimmune disorder (in which the immune system mistakenly attacks healthy melanocytes). Others think it is a genetic condition, as affected kids often have a family member who also has it.

What is known is that the risk of developing vitiligo increases in kids with a family or personal history of thyroid disease, diabetes, and certain conditions like alopecia (an autoimmune disease that causes hair loss). Vitiligo is never contagious — kids can't "catch" it from someone else.

How Is Vitiligo Diagnosed?

A dermatologist usually can make a diagnosis of vitiligo just by looking for the telltale white patches on the skin. On kids with very fair skin, they might use a special tool called a Woods lamp. This lamp uses ultraviolet light in a dark room to illuminate areas of affected skin that would otherwise be hard to see with the naked eye.

The doctor will also ask lots of questions about your child's medical history, including:

• whether anyone in the family has had skin conditions or autoimmune problems
• whether your child recently had a rash or sunburn
• if your child has had any other illnesses or been under stress

A blood test may be done to check for thyroid problems and diabetes.

Very rarely, the doctor may do a biopsy (where a small piece of the affected skin is removed to be analyzed in the lab). A biopsy lets the doctor check for pigment cells in the skin. If the biopsy shows there are no pigment cells, this may confirm a case of vitiligo.

How Is Vitiligo Treated?

There is no "cure" for vitiligo. Some patches will clear up without treatment. For those that don't, treatments can help to even out the skin tone. You can try some at home; others require treatment by a doctor. Just remember that results can vary — what works for one person may not work for another, and no treatment is likely to be 100% effective at making the spots disappear.

Here are ways to help if your child has vitiligo:

• Sunscreen. One of the most important things your child can do is wear sunscreen every day to protect against skin cancer. And because vitiligo spots can't tan (they have no melanin), they may burn and scar. Getting a tan on the rest of the body will only highlight white patches even more, especially if a child has light skin.
• Cosmetics. Different kinds of over-the-counter concealers are available. Ask your doctor for recommendations and try different brands until you find the one that works best for your child.
• Corticosteroid creams. Corticosteroids are a type of medicine which, when applied to white patches very early in the disease, may help to "repigment" the skin. They reduce the inflammation that causes a loss of pigment so that pigmented cells can return to the skin. Some non-steroidal creams also produce a similar effect.
• Photochemotherapy with ultraviolet A (also known as PUVA). PUVA has two steps: first, a medicine 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 usually 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. There are side effects, which may include severe sunburn and skin blistering. Other side effects may be more serious, so talk to your doctor about the risks involved.
• Narrow-band ultraviolet B (UVB) therapy. This treatment is more widely used than PUVA. It's similar to PUVA, except that the ultraviolet light used is UVB instead of UVA. Also, no psoralen is required beforehand, which prevents some of the side effects.

Researchers are also 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.

When deciding which, if any, treatment to try, be wary of quick-fix "miracle" remedies you might see advertised. If it seems too good to be true, it probably is. Always work with your child's doctor to help you decide what's best.

What Else Should I Know?

If your child has vitiligo, you know that even though it isn't dangerous to their physical health, it can still be a big deal. Any condition that makes kids look different from their peers can be emotionally tough, especially during the preteen and teen years when everyone tries to fit in.

Some kids are naturally more resilient and do fine against these challenges. But others need a bit more help. As a parent, you can do a lot to boost your child's confidence and self-esteem. Here are a few tips:

• Don't focus on the vitiligo or put pressure on your child to cover it up. They need to know your love and acceptance are unconditional.
• Remind your child of all the things at which they excel, and how those have nothing to do with skin color.
• Teach your child to be comfortable explaining what vitiligo is — and isn't — to other kids. When the mystery is taken away, most kids will stop staring and asking questions.
• Encourage your child to say yes to play dates, pool parties, trips, and any other experiences they might be tempted to pass on because of the vitiligo.
• Urge your child to volunteer or get involved in the community. Giving back makes kids feel powerful.

Finally, get emotional support if your child needs it — especially if you see any signs of withdrawal, depression, or anxiety. Counselors, therapists, and vitiligo support groups can help. Find a support group near you online at:

• Global Vitiligo Foundation