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Vitiligo – An Overview

Updated on February 17, 2020

Article written by
Alison Channon

Medically reviewed by
Richard H. Huggins, MD

Vitiligo is a skin condition in which people lose skin pigment and develop patches of lighter skin.1 Vitiligo is not contagious – no one can “catch” vitiligo through physical contact, sexual activity, or sharing utensils with a person with vitiligo.2

What Is Vitiligo?


Vitiligo is a condition resulting in patches of depigmented skin.1 Vitiligo can be widespread or affect only a small area of the body.3 While the primary symptom of vitiligo is skin discoloration, people with vitiligo can also experience hearing loss, eye inflammation, and other autoimmune conditions.4,5

What Causes Vitiligo?

Vitiligo occurs when melanocytes, the cells responsible for skin pigmentation, are destroyed.6 Most scientists believe that vitiligo is an autoimmune condition – meaning the immune system is attacking the body’s own tissues. In the case of vitiligo, the body attacks and destroys melanocytes.7 The scientific consensus is that a combination of genetic and environmental factors contribute to vitiligo.8

Genetic Factors

About one in five people with vitiligo have a close relative with the condition, though there is no clear pattern of inheritance from parents.9 Researchers have identified more than 30 genes associated with increased risk for vitiligo.10

Environmental Factors

Vitiligo may occur when a person genetically predisposed to develop vitiligo experiences an external event that triggers vitiligo. Possible triggering events include sunburn, chemical exposure, emotional stress, or trauma to the skin such as excessive rubbing or scratching.11

Learn more about vitiligo causes and risk factors.

The History of Vitiligo

The term vitiligo comes from the Latin word vitulum, translated as “small blemish.”12 Descriptions of what modern scholars believe is vitiligo appear in ancient texts. The earliest mention of vitiligo is believed to date back to approximately 1500 BCE in an Egyptian medical text called the Ebers Papyrus. Descriptions of what may be vitiligo also appeared in an Indian medical text in approximately 800 BCE and in Greek histories from the fifth century BCE.13

Early descriptions of skin conditions that can be interpreted as vitiligo are also found in religious texts, including the Hebrew Bible, the Hindu scripture Atharva Veda, and a compilation of Shinto prayers from Japan.13

The stigma associated with vitiligo and other skin conditions dates back to some of these early documents. The Hebrew Bible makes many references to white spots, which may have been vitiligo, but were historically associated with leprosy. In the Bible, people with skin conditions were ostracized. Those afflicted were considered unclean, and their skin was viewed as a sign of divine punishment. The Greek historian Herodotus, who lived in the fifth century BCE, believed people with vitiligo or other skin conditions had been punished by the sun and should be exiled from the community.14

People with vitiligo and other skin pigmentation conditions were not ostracized in all cultures. In a 17th-century Korean portrait, a high-ranking government official is painted with signs of vitiligo on his face and neck, indicating that his skin did not prevent him from attaining a position of power.12

European scientists in the second half of the 1800s greatly advanced the modern understanding of vitiligo. In the 1870s, Austrian scientist Moriz Kaposi first observed the lack of pigment in skin cells. In the same decade, a Norwegian doctor named Gerhard Hansen identified a bacterial cause for leprosy. These advancements helped to distinguish between the two conditions.12

People have attempted to treat vitiligo since it was first identified. Early treatments included applying ground dark-colored seeds and herbs to the areas of depigmentation, tattooing, and burning.14 Some early treatments were precursors to modern-day treatments, including early forms of phototherapy.12

How Common Is Vitiligo?

Vitiligo is estimated to impact about 0.5 to 2 percent of the global population. Vitiligo is more common in certain geographic regions. For instance, nearly 9 percent of people in Gujarat in Western India have vitiligo.2 While vitiligo may be more prominent in some parts of the world, anyone, regardless of race, ethnicity, or sex can develop vitiligo.15

Types of Vitiligo

There are two main types of vitiligo – generalized vitiligo and segmental vitiligo. They both occur when the cells that create skin pigmentation are destroyed. However, the two types present differently on the body.1

Generalized vitiligo

Generalized vitiligo affects about nine in 10 people with vitiligo.16 People with generalized vitiligo usually develop symmetrical areas of skin depigmentation on each side of the body. The first symptoms often appear on the on the hands, feet, elbows, armpits, or face.3 Other terms for generalized vitiligo include non-segmental vitiligo, bilateral vitiligo, or vitiligo vulgaris.1

Segmental Vitiligo

Segmental vitiligo affects about one in 10 people with vitiligo and is more common in children.16 Unlike generalized vitiligo, segmental vitiligo usually affects just one side of the body.3 For this reason, segmental vitiligo is also called unilateral vitiligo.1

Learn more about vitiligo types.

How Is Vitiligo Treated?

There is no cure for vitiligo, but treatments can help manage the loss of skin pigment or return pigmentation for some individuals with vitiligo.17

Categories of treatment options include:

  • Topical medications are often the first treatment option prescribed for vitiligo. They tend to work best on the face and upper body, on newly developed areas of vitiligo, and on people with darker skin tones.18,19
  • Oral medications, usually oral corticosteroids, may be prescribed if vitiligo is progressing quickly.18
  • Phototherapy, or light therapy, uses different types of ultraviolet lights to restore skin pigmentation.19 Phototherapy has been found to be effective in 65 to 75 percent of people treated, however it requires a major time commitment to see results.18
  • Surgery is a potential option for adults who haven’t found success with other treatments. Vitiligo surgical techniques usually require transferring pigmented skin or skin cells to a depigmented area.19
  • Depigmentation, the process of removing pigment from the skin to even out skin tone, may be an option for adults whose skin is 50 percent covered with vitiligo patches.19,20 Depigmentation is permanent.

Many people choose not to undergo treatment for vitiligo. Some use cosmetics to camouflage areas of depigmentation, while many people are comfortable allowing their skin to show. Learn more about treatments for vitiligo.

What Are the Symptoms of Vitiligo?

Patches of skin discoloration are the most prominent symptom of vitiligo. Areas of depigmentation can appear slightly lighter than the rest of the body, completely white, or pink, red, or brown.1,16 Vitiligo can appear on any part of the body.1 It commonly affects the face, neck, hands, arms, knees, feet, and genitals.1,15,21

Vitiligo can also impact the eyes and hearing, because the same cells that lose pigment in the skin are found in the inner ears and eyes.4

In addition to the physical symptoms of vitiligo, many people experience social isolation, depression, and anxiety due to feelings of embarrassment or social stigma.22 Therapy and social support through groups like MyVitiligoTeam can help you manage emotional difficulties that can come with vitiligo.23

Learn more about symptoms of vitiligo.

Related Conditions

Autoimmune conditions affect about 15 to 25 percent of people with vitiligo.24 Thyroid autoimmune diseases are among the most common autoimmune conditions in people with vitiligo.25 People with vitiligo may also have autoimmune illnesses that impact the skin, muscles, joints, and connective tissue, like lupus, psoriasis, and rheumatoid arthritis.26

Learn more about health conditions related to vitiligo.

Condition Guide

Resources

External resources

Internal resources

FAQs

Who treats vitiligo?
Vitiligo is usually treated by a dermatologist, though it can also be treated by a primary care doctor.19,27

How is vitiligo diagnosed?
In order to diagnose vitiligo, a dermatologist will usually take a medical history, conduct a physical examination, and occasionally order bloodwork or a biopsy.2,28 Learn more about diagnosing vitiligo.

References

  1. Vitiligo: Signs and symptoms. (n.d.). Retrieved October 31, 2019, from https://www.aad.org/diseases/a-z/vitiligo-symptoms.
  2. Lotti, T., & Salafia, A. (n.d.). Vitiligo Questions & Answers. New York, NY: VR Foundation.
  3. Nordlund, J. (2011). Vitiligo: A review of some facts lesser known about depigmentation. Indian Journal of Dermatology, 56(2), 172. doi: 10.4103/0019-5154.80413
  4. Is vitiligo a medical condition? (n.d.). Retrieved October 31, 2019, from https://www.aad.org/diseases/a-z/is-vitiligo-a-medical-condition.
  5. About Vitiligo. (n.d.). Retrieved October 31, 2019, from https://vrfoundation.org/about_vitiligo.
  6. Vitiligo: Who Gets and Causes. (n.d.). Retrieved November 8, 2019, from https://www.aad.org/diseases/a-z/vitiligo-causes.
  7. Vitiligo: MedlinePlus Medical Encyclopedia. (2018, November 19). Retrieved November 8, 2019, from https://medlineplus.gov/ency/article/000831.htm.
  8. Harris, J. E. (2017, January 17). What causes vitiligo? - UMass Vitiligo Clinic & Research Center. Retrieved November 8, 2019, from https://www.umassmed.edu/vitiligo/blog/blog-posts1/2017/01/answer-to-what-causes-vitiligo/.
  9. Harris, J. E. (2014, June 21). Will my children/family get vitiligo? Retrieved November 8, 2019, from https://www.umassmed.edu/vitiligo/blog/blog-posts1/2014/06/will-my-childrenfamily-get-vitiligo/.
  10. Vitiligo - Genetics Home Reference - NIH. (2019, October 29). Retrieved November 8, 2019, from https://ghr.nlm.nih.gov/condition/vitiligo#inheritance.
  11. Manga, P., Elbuluk, N., & Orlow, S. J. (2016). Recent advances in understanding vitiligo. F1000Research, 5, 2234. doi: 10.12688/f1000research.8976.1
  12. Millington, G and Levell, N (2006) Vitiligo: The historical curse of depigmentation. Poster session presented at 64th Annual Meeting of the American Academy of Dermatology, San Francisco, CA.
  13. Kopera, D. (1997). Historical aspects and definition of vitiligo. Clinics in Dermatology, 15(6), 841–843. doi: 10.1016/s0738-081x(97)00124-7
  14. Nordlund, J. J. (2017). The Medical Treatment of Vitiligo: An Historical Review. Dermatologic Clinics, 35(2), 107–116. doi: 10.1016/j.det.2016.11.001
  15. Vitiligo Signs & Symptoms. (n.d.). Retrieved from https://www.avrf.org/facts/vitiligo-signs-symptoms.html.
  16. Overview: Vitiligo. (n.d.). Retrieved October 31, 2019, from https://www.nhs.uk/conditions/vitiligo/.
  17. Medical Screening. (n.d.). Retrieved October 31, 2019, from https://www.avrf.org/facts/medical-screening.html.
  18. Treatment Guidelines. (n.d.). Retrieved November 1, 2019, from https://vrfoundation.org/treatment_guidelines.
  19. Vitiligo: Diagnosis and Treatment. (n.d.). Retrieved November 1, 2019, from https://www.aad.org/diseases/a-z/vitiligo-treatment.
  20. Benoquin - FDA prescribing information, side effects and uses. (2019, October 1). Retrieved November 1, 2019, from https://www.drugs.com/pro/benoquin.html#s-34067-9.
  21. Vitiligo. (2019, October 21). Retrieved November 1, 2019, from https://www.niams.nih.gov/health-topics/vitiligo.
  22. Vernwal, D. (2017). A study of anxiety and depression in Vitiligo patients: New challenges to treat. European Psychiatry, 41. doi: 10.1016/j.eurpsy.2017.02.242
  23. Rzepecki, A. K., McLellan, B. N., & Elbuluk, N. (2018). Beyond Traditional Treatment: The Importance of Psychosocial Therapy in Vitiligo. Journal of Drugs in Dermatology, 17(6), 688–691.
  24. Vitiligo - Genetics Home Reference. (2019, November 12). Retrieved November 20, 2019, from https://ghr.nlm.nih.gov/condition/vitiligo.
  25. Baldini, E., Odorisio, T., Sorrenti, S., Catania, A., Tartaglia, F., Carbotta, G., … Ulisse, S. (2017). Vitiligo and Autoimmune Thyroid Disorders. Frontiers in Endocrinology, 8, 1–6. doi: 10.3389/fendo.2017.00290
  26. Elbuluk, N., & Ezzedine, K. (2017). Quality of Life, Burden of Disease, Co-morbidities, and Systemic Effects in Vitiligo Patients. Dermatologic Clinics, 35(2), 117–128. doi: 10.1016/j.det.2016.11.002
  27. Plensdorf, S., Livieratos, M., & Dada, N. (2017). Pigmentation Disorders: Diagnosis and Management. American Family Physician , 96(12), 797–804. Retrieved from https://www.aafp.org/afp/2017/1215/p797.html.
  28. Diagnosing Vitiligo. (n.d.). Retrieved November 15, 2019, from https://nyulangone.org/conditions/vitiligo/diagnosis.

Alison has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her here.

Dr. Richard H. Huggins is the author of numerous journal articles and chapters studying treatments and quality of life for people with vitiligo and other skin conditions. Learn more about him here.

In partnership with the Global Vitiligo Foundation

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