Vitiligo

Symptoms of vitiligo

The patches are vulnerable to sunburn, so it's important to take extra care in the sun. The condition varies from person to person. Some people only get a few small, white patches, but others get bigger white patches that join up across large areas of their skin.

The white patches are usually permanent.  Vitiligo affects about one person in every 100. It affects men and women equally. It affects people with different skin types or ethnicity the same; however, vitiligo is more commonly diagnosed in women and people with darker skin pigmentation.

Areas most commonly affected include:

• the skin around the mouth and eyes
• fingers and wrists
• armpits
• groin
• genitals
• inside the mouth

It can also develop where there are hair roots, such as on your scalp. The lack of melanin in your skin can turn the hair in the affected area white or grey.

Vitiligo often starts as a pale patch of skin that gradually turns completely white. The centre of a patch may be white, with pale skin around it. If there are blood vessels under the skin, the patch may be slightly pink.

The edges of the patch may be smooth or irregular. They're sometimes red and inflamed, or there's brownish discolouration (hyperpigmentation). Vitiligo doesn't cause discomfort to your skin, but the patches may occasionally be itchy.

Types of vitiligo

There are two main types of vitiligo:

• non-segmental vitiligo (bilateral or generalised vitiligo)
• segmental vitiligo (unilateral or localised vitiligo)

In rare cases, vitiligo can affect your whole body. This is known as universal (complete) vitiligo.

In non-segmental vitiligo the symptoms often appear on both sides of your body as symmetrical white patches.

Symmetrical patches can appear on the:

• backs of your hands
• arms
• skin around body openings, such as the eyes
• knees
• elbows
• feet

It’s the most common type of vitiligo, affecting around nine out of 10 people with the condition.

In segmental vitiligo the white patches only affect one area of your body. It’s less common than non-segmental vitiligo, although it's more common in children.

Causes of vitiligo

Vitiligo is caused by the lack of a pigment called melanin in the skin. Melanin is produced by skin cells called melanocytes, and it gives your skin its colour. In vitiligo, there aren't enough working melanocytes to produce enough melanin in your skin causing white patches to develop.

Causes of non-segmental vitiligo

Non-segmental vitiligo is thought to be an autoimmune condition. In autoimmune conditions, the immune system doesn't work properly. Instead of attacking foreign cells your immune system attacks healthy cells.

If you have non-segmental vitiligo, your immune system destroys the melanocyte skin cells that make melanin. Vitiligo is also associated with other autoimmune conditions, such as hyperthyroidism (an overactive thyroid gland). Not everyone with vitiligo develops these conditions.

You may be at increased risk of developing non-segmental vitiligo if:

• other members of your family have it
• there's a family history of other autoimmune conditions
• you have another autoimmune condition
• you’ve melanoma (a type of skin cancer)
• cutaneous T-cell lymphoma (cancer of the lymphatic system)
• you’ve particular changes in your genes that are known to be linked to non-segmental vitiligo

It's possible that vitiligo may be triggered by:

• stressful events, like childbirth
• skin damage, such as severe sunburn or cuts
• exposure to certain chemicals

Vitiligo isn't caused by an infection. You can't catch it from someone else who has it.

Causes of segmental vitiligo

Segmental vitiligo is thought to be caused by chemicals released from the nerve endings in your skin. These chemicals are poisonous to the melanocyte skin cells.

Diagnosing vitiligo

Your GP will be able to diagnose vitiligo after examining the affected areas of skin.

They may ask whether:

• there's a history of vitiligo in your family
• there's a history of other autoimmune conditions in your family
• you've injured the affected areas of skin – for example, whether you've had sunburn or a severe rash there
• you tan easily in the sun, or whether you burn
• any areas of skin have got better without treatment, or whether they're getting worse
• you've tried any treatments already

Your GP may also ask you about the impact vitiligo has on your life.

For example:

• how much it affects your confidence and self-esteem
• whether it affects your job

Other autoimmune conditions

As non-segmental vitiligo is closely associated with other autoimmune conditions, you may be assessed to see whether you have any symptoms that could suggest an autoimmune condition, such as:

• being tired and lacking energy (signs of Addison's disease)
• being thirsty and needing to urinate often (signs of diabetes)

A blood test may also be needed to check how well your thyroid gland is functioning.

Treating vitiligo

The white patches caused by vitiligo are usually permanent. Treatment options are available to improve the appearance of your skin.

If the patches are small, skin camouflage cream can be used to cover them up. Your GP may refer you to a dermatologist (a hospital doctor specialising in skin conditions) who can discuss treatment options with you to decide the best treatment for you. Although treatment may help restore colour to your skin, the effect doesn't usually last. Treatment can't stop the condition spreading.

Complications of vitiligo

Vitiligo can sometimes cause other problems. Because of a lack of melanin, your skin will be more vulnerable to the effects of the sun. Make sure you use a strong sunscreen to avoid sunburn.

Vitiligo may also be associated with problems with your eyes and hearing, such as:

• inflammation of the iris (iritis)
• partial loss of hearing (hypoacusis)

Problems with confidence and self-esteem are common in people with vitiligo, particularly if it affects areas of skin that are often exposed.

• Protection from the sun

Help and support

Support groups can provide help and advice, and may be able to put you in contact with other people with vitiligo.

Your GP may suggest a group in your local area. Charities such as The Vitiligo Society may also be able to help.

• Find out more about vitiligo on the NHS website

More useful links

• How to use your health services