Vitiligo: Important Facts and Treatment Options

What causes vitiligo?

Vitiligo happens when the immune system attacks the pigment cells (melanocytes) in the skin, so they stop producing colour in certain areas. Genetics play a role and more than one family member may be affected; it can start or flare after severe stress, sunburn or a skin injury.

In some patients vitiligo is linked to other autoimmune conditions, most often thyroid disorders, so your doctor may request simple blood tests at diagnosis. Popular beliefs about combining certain foods, such as fish and milk, have no scientific basis.

Facts and myths about vitiligo

Vitiligo is surrounded by misinformation that causes patients needless embarrassment, so it is important to correct it:

• Vitiligo is not contagious and does not spread through touch, handshakes or sharing food and utensils.
• It is not caused by eating fish with milk or any particular food.
• It does not turn into skin cancer, but white skin burns easily in the sun and needs protection.
• Vitiligo is not albinism, a different inherited condition in which colour is missing from the whole skin from birth.
• Not every light patch is vitiligo; tinea versicolor and some inflammations also leave pale patches.

What types of vitiligo are there, and how is it diagnosed?

The most common type is non-segmental vitiligo, where patches usually appear symmetrically on both sides, such as around the eyes and mouth, on the hands, elbows and knees, and may spread over time. Segmental vitiligo affects one side or one area of the body, often starts at a young age and then usually stabilises.

A dermatologist usually diagnoses vitiligo by examination and may use a Wood's lamp, which shows the patches more clearly and helps distinguish them from other causes of pale patches. A skin sample is rarely needed.

What are the treatment options for vitiligo?

Treatment aims to stop patches spreading and encourage colour to return. Your doctor chooses a plan based on the type, extent, location and activity of the vitiligo; all of these are prescription treatments that need follow-up:

• Topical cortisone creams for set periods, especially for recent patches.
• Topical calcineurin inhibitors, often used on the face, neck and delicate areas.
• Newer JAK inhibitor creams, approved in some countries for certain types of vitiligo.
• Narrowband UVB phototherapy, or excimer light for small patches, in regular sessions over several months.
• Short courses of oral medicines when vitiligo is spreading quickly, at the doctor's discretion.
• Surgical pigment cell grafting in selected cases of stable vitiligo that has not changed for a long time.

What can you expect from treatment, and how should you care for your skin?

Colour returns slowly, and it may take months before small dots of colour appear inside the patches. The face and neck usually respond better than the hands and feet, results vary from person to person, and some patches can return after improving, so maintenance treatment may be needed.

Sunscreen is very important in our sunny climate, because white patches burn quickly and sunburn can make vitiligo more active. Sunscreen also reduces the contrast between the patches and the surrounding skin, and special cosmetic products can cover patches if the patient wishes. Do not hesitate to seek emotional support if vitiligo affects your confidence.