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In partnership with the Global Vitiligo Foundation ?

Facial Vitiligo: Diagnosis and Treatment

Updated on September 30, 2022

Vitiligo is a chronic condition that causes areas of skin to lose its natural pigment (coloring), resulting in white patches. Facial vitiligo is usually seen in patches around the mouth, eyes, nose, and ears.

Vitiligo is not dangerous or contagious and has no connection with skin cancer, leprosy, albinism, or an infectious disease. However, vitiligo on the face can significantly affect a person’s appearance — because of this, facial vitiligo can negatively affect a person’s self-esteem and quality of life. If vitiligo’s effect on your appearance bothers you, you may be interested in treatment.

This article explains what to expect from diagnosis as well as what treatment options are available for facial vitiligo.

What Causes Facial Vitiligo?

The white patches characteristic of vitiligo occur when melanocytes (cells responsible for activating melanin, the pigment in your skin) are destroyed by the immune system. Most dermatologists believe this skin condition has characteristics of an autoimmune disease, in which the immune system attacks the body’s cells. Other potential risk factors for facial vitiligo include:

  • Genetics
  • Sunburn or sun damage from harmful ultraviolet (UV) B rays
  • Stress
  • Exposure to certain chemicals
  • Family history of vitiligo or other autoimmune conditions, such as thyroid disease or alopecia areata

How Is Facial Vitiligo Diagnosed?

Facial vitiligo usually starts as a small white spot that looks different from your normal skin color and spreads over time. People have also reported itching, inflammation, and redness.

About 95 million people around the world experience a form of vitiligo, half of whom start seeing signs of the condition in childhood or before the age of 21. If you suspect that you have facial vitiligo, visit your doctor or a dermatologist, who will conduct a comprehensive exam. This assessment may include asking questions about your medical and family history (including a family history of vitiligo), your exposure to environmental factors such as the sun and chemicals, and any recent stressful events.

Segmental vitiligo of the face only occurs on one side. The spots can affect any part of the face in this type of vitiligo, but they do not cross over to the other side. There is also a “lip-tip” variant of vitiligo in which a person loses pigment around the mouth and near the fingertips.

Physical Exam

A physical assessment may include using a UV lamp, known as a Wood’s lamp, to examine the affected areas on your face that have white patches. Depigmented white spots will glow under UV light. Use of the lamp helps doctors determine if the patches are due to vitiligo or another skin condition that may be similar to vitiligo, such as:

  • Nevus depigmentosus (birthmark)
  • Albinism
  • Hypopigmented spots
  • Melasma
  • Pityriasis alba

Biopsy

The doctor may decide to do a skin biopsy to look at a portion of skin under the microscope to confirm the absence of melanocytes before officially diagnosing vitiligo.

Blood Test

Other autoimmune diseases, including thyroid disease, type 1 diabetes, and alopecia areata (sudden hair loss), have also been associated with vitiligo. A doctor may order a blood test or other diagnostic screenings to rule out these conditions. However, there is not currently a blood test for vitiligo.

Facial Vitiligo Treatments

Vitiligo is a permanent condition that does not have a cure. It is not dangerous, and you don’t need to treat or cover it if you don’t want to. If you are interested in vitiligo treatment, you have options.

Treatments can help cover up white facial patches or help address the underlying cause of these patches. The type of vitiligo you have, in combination with other health factors such as your age, the area of the face affected, and your overall health and well-being, will help determine your best treatment option.

Cosmetics

Concealing makeup and self-tanning lotions are a safe and cost-effective way of covering up facial vitiligo for adults and children. You may need to try several types of makeup before you find one that matches your skin and feels comfortable for you. Some brands can be matched to your skin color to best cover it up.

Sun Protection

Sunburn can trigger vitiligo in some people or make the patches spread. For this reason, it is important to always use sunscreen and to take extra care of your skin when your face is exposed to the sun. Also, these depigmented areas may burn more easily and skin cancer can occur in these areas.

Topical Treatments

Topical creams and ointments have been proved to reduce the signs of facial vitiligo effectively and improve skin color in about 45 percent of people. These medications contain a potent corticosteroid that is usually well-tolerated. However, it can result in several side effects from long-term use, including thinning and drying of the skin as well as acne. Consult with a doctor before using a steroid cream or ointment on your face.

Tacrolimus (Protopic) is a topical ointment treatment that doesn’t contain steroids. It may help suppress the immune response responsible for vitiligo skin patches. A similar cream form called pimecrolimus (Elidel) may also be effective in treating facial vitiligo without the side effects of steroid creams.

In 2022, the U.S. Food & Drug Administration (FDA) approved the first medication for repigmentation in people with vitiligo. Opzelura (ruxolitinib) is a topical Janus kinase (JAK) inhibitor cream for individuals age 12 or older with nonsegmental vitiligo.

JAK proteins are responsible for sending signals that are involved in telling your immune system to attack the melanocytes in the skin — which leads to depigmentation, or light-colored spots. By inhibiting the JAK proteins, that signal doesn’t get sent and the melanocytes can deliver color back to your skin. Ruxolitinib must be prescribed by your health care provider, so talk to your dermatologist if you have questions about whether it might be right for you.

Ultraviolet Light Treatment

Phototherapy with narrowband UVB light using a light box or excimer laser has been found to work well in treating facial vitiligo, and 70 percent of people see positive results. These treatments can be time-consuming, with required visits two or three times per week over several weeks. Results tend to fade over time and maintenance treatment may be required.

PUVA Treatment

Although much less commonly used than narrowband UVB, PUVA is another form of light treatment that combines UVA light with a medication called psoralen. Extracted from plants, psoralen makes skin cells more sensitive to light. PUVA is found to be about 75 percent effective in treating facial vitiligo. It must be administered in a hospital or outpatient center twice a week for several months to a year. The psoralen, which is taken orally or applied as a cream, can also make your eyes sensitive to light. You’ll need to take extra precautions to protect your eyesight after treatment.

Surgery

If you don’t respond well to topical or light therapies, surgery may be an option. Most surgical options involve skin grafting that uses normally pigmented skin grafted to vitiligo spots to help regenerate pigment in areas of the body that are affected by vitiligo. Surgery is not recommended for children. Surgery may also cause infection and cobblestonelike skin.

Vitiligo and Self-Acceptance

Research on vitiligo treatments and causes is ongoing, but another important option with positive outcomes is cultivating self-acceptance. Choosing not to treat facial vitiligo and focusing on appreciating what makes you different from others can be freeing. Connecting with others who have vitiligo, either online or in person, can help with this.

Connect With Others Who Understand

MyVitiligoTeam is the social network for people with all types of vitiligo. More than 11,000 members come together to ask questions, give advice, and share their experiences with others who understand life with vitiligo.

Do you have facial vitiligo? Share your experience in the comments below or start a discussion on MyVitiligoTeam.

    In partnership with the Global Vitiligo Foundation, which strives to improve the quality of life for individuals with vitiligo through education, research, clinical care, and community support.

    All updates must be accompanied by text or a picture.
    Amit G. Pandya, M.D., President of the Global Vitiligo Foundation is a dermatologist at the Palo Alto Medical Foundation in Mountain View, California. Learn more about him here.
    Amy Isler, RN is a registered nurse with over six years of experience as a credentialed school nurse. Learn more about her here.

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