Vitiligo is an autoimmune condition that attacks the pigment producing cells, called melanocytes, and causes the skin to de-pigment or turn white. Only about one percent of people in the world will develop vitiligo and there is no known cause of it, although around 25 percent will have a family history of vitiligo.
Vitiligo can occur at any age, but most frequently begins in the patient’s twenties. The most common type is generalized vitiligo that occurs around the mouth and eyes and on over joints such as the knees and elbows. Other forms will involve just one spot, the inside mouth, or the entire body. Skin that has been traumatized will be more likely to develop vitiligo. Although it can be extremely disfiguring, especially when it involves the face of a darker-skinned individual, it does not have to be, especially when confined to small areas on the trunk or extremities.
A vitiligo diagnosis can be clinically and confirmed with a simple biopsy. The pathologist will see a lack of melanocytes in the specimen. This will distinguish it from other hypo-pigmenting disorders that may cause the skin to lighten but does will retain the melanocytes. The areas that have vitiligo can sunburn, so wearing sunscreen and sun avoidance are key.
A range of treatments are available. Topical steroids, oral steroids and topicals such as tacrolimus and primecrolimus are available. Topical Vitamin D preparations are available with fewer side effects, but with less efficacy. Laser and UV light therapies are available, but can be expensive. In patients with large body surface areas affected, using a fade cream to fade the normal skin to match the vitiligo skin may be a better option. There are several other new treatment options; there is no cure for it.
Many other autoimmune diseases may occur with vitiligo such as thyroid disease, type one diabetes, Lupus and pernicious anemia. Patients with suspected vitiligo should have a full work-up with a primary care provider to rule these out.