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.
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:
Focal vitiligo. A person has a few vitiligo spots in a single
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.
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.
Experts don't know exactly what causes vitiligo, but they do have theories. Some
think it's an
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).
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
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.
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.
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
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
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.