Vitiligo and Loss of Skin Color

Medically Reviewed by Zilpah Sheikh, MD on May 07, 2024
Written by Frances Gatta, Melissa Conrad Stöppler, MD, Kristin Mitchell
10 min read

Vitiligo is a long-lasting condition that causes a loss of color in patches on the skin. It happens when the body's immune system mistakenly attacks and destroys the skin cells that make color or pigment (melanocytes), turning the affected skin milky white.

Any location on the body can be affected, and most people with vitiligo have white patches on many areas. These patches can show up on the same area on both sides of the body, such as on your hands or knees. They can also appear suddenly, covering a large area of your skin.

 

When the body's immune system attacks and destroys its melanocytes, which make melanin. The loss of melanin causes the skin to lose its characteristic color.

It is unclear what triggers the immune system to attack melanocytes in the skin. Research suggests sunburn, emotional distress, exposure to a chemical pollutant, or other stressful events can trigger or worsen vitiligo.

Although vitiligo affects all races equally, it's more noticeable in dark-skinned people.

Is vitiligo genetic?

More research is needed to understand what causes vitiligo, but studies show that 30% of cases are genetic.

Vitiligo is related to gene changes involved in immune system function or melanocytes. Researchers have identified over 30 genes having variations that make you more likely to have vitiligo. NLRP1 and PTPN22 are two of these genes.

Vitiligo may be due to both genetics and environmental factors. However, many of these factors are unknown.

Up to 2% of the population and an estimated 2 million to 5 million Americans have the condition. It doesn't matter what your sex is.

It usually develops early in life, between ages 10 and 30. It will almost always show up before age 40.

Vitiligo may run in families. You're more likely to get it when someone in your family has it, too, or when your family gets gray hair prematurely.

Autoimmune diseases can also raise your odds. These conditions include:

  • Autoimmune thyroid disease (Hashimoto's thyroiditis)
  • Type 1 diabetes
  • Addison’s disease
  • Pernicious anemia
  • Psoriasis
  • Rheumatoid arthritis
  • Systemic lupus erythematosus

You may also be likely to have vitiligo if you have a family member who has had these autoimmune diseases.

You'll often lose pigment quickly on several areas of your skin. After the white patches appear, they may stay the same for a while but get bigger later. You may have cycles of pigment loss and stability.

Vitiligo commonly affects:

  • Body folds (such as armpits)
  • Places that have been injured in the past
  • Areas exposed to the sun
  • Around moles
  • Around body openings
  • Mucous membranes (tissues that line your nose and mouth)
  • Eyelids
  • Hair

It's rare for pigment to return once the white patches have developed.

You may also have symptoms of other autoimmune diseases along with vitiligo, such as:

  • A goiter or enlarged thyroid glands
  • Anemia or low levels of healthy red blood cells
  • Extreme weight and muscle loss
  • Premature grey hair
  • Patchy hair loss
  • Weakness

There are five types of vitiligo. The type you have depends on where it's located.

  • Generalized vitiligo is the most common type, in which discolored patches show up all over your body.
  • Segmental vitiligo is when your vitiligo happens only in one area of your body, such as your face or hands.
  • Focal vitiligo happens when the discoloration stays in one spot and doesn't spread.
  • Trichrome vitiligo is when there is an area of heavy discoloration, followed by an area of lighter discoloration, and then regular-color skin.
  • Universal vitiligo is a rare type. If you have this, at least 80% of your skin will lose its color.

Your doctor can usually diagnose vitiligo by looking at your skin during a physical exam and asking if your family has had a history of vitiligo or other autoimmune conditions. You might also have other tests, including:

  • Blood tests for other autoimmune diseases
  • Skin biopsy, where a sample of your skin is sent to a laboratory for more testing
  • A Wood's lamp test, where a doctor looks at your skin under UV light. If you have vitiligo, the affected skin will look chalky and bright
  • An eye exam to see if you have uveitis or inflammation of the eye, which may happen when you have vitiligo

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Tinea versicolor is a fungal skin infection of the skin. Unlike vitiligo, where the milky-white patches are smooth milky white, tinea versicolor causes white, brown, tan, and salmon scaly patches. Tinea versicolor goes away after being treated with antifungal medications you take by mouth or apply on your skin, but it may return. Vitiligo doesn’t go away at all.

A doctor may be the best person to tell what condition may be causing your skin symptoms.

Albinism is a skin condition that runs in the family. It happens you have inherited mutated genes that cause abnormal melanocytes that can't properly make or distribute melanin throughout the skin, causing your skin, hair, and eyes to look pale.

In vitiligo, on the other hand, melanocytes are destroyed and the affected areas of the skin appear in milky-white patches.

Also, albinism appears at birth, whereas vitiligo usually develops over time and typically appears before age 40.

Studies are ongoing about whether vitiligo can be passed down; they indicate that 30% of vitiligo cases are genetic.

There's no known way to prevent or cure vitiligo. But you can make your affected skin look better. Which treatment may work best for you depends on how old you are, how much your skin needs improving, and how much your vitiligo affects you.

Your doctor may treat the condition by recommending therapies to:

  • Slow down the progression of vitiligo
  • Help melanocytes grow back
  • Restore color to the areas with milky-white patches

It might take some time for the treatment to work, and you might get new patches during this time. Your doctor might also suggest you follow multiple treatments to get the most benefit.

Medications for vitiligo

The FDA has approved ruxolitinib (Opzelura) cream for the treatment of nonsegmental vitiligo in kids age 12 or older and adults. It has shown success in repigmentation when applied twice daily for 6 months on affected skin covering up to 10% of body surface area.

Otherwise, your doctor may prescribe a corticosteroid cream to put on the affected skin to try to give it its color back. It may take months to see changes in your skin. You might also see some streaks or lines on your skin, or your skin may get thinner.

If your vitiligo is progressing quickly, your doctor might suggest a corticosteroid pill or injection.

In rare cases, they may suggest an ointment called a calcineurin inhibitor ointment. It affects your immune system to ease inflammation. You might get it if your vitiligo is in a small area, usually around your face and neck. Doctors don't prescribe these often, as these medicines are linked to skin cancer and lymphoma.

Therapies for vitiligo

There are a few different techniques that can help.

Phototherapy. Also called light therapy, it uses UVA light, which can slow or stop the progression of your vitiligo. In most cases, you'll do this in combination with any medicines your doctor prescribes. Usually, you'll get this therapy a few times a week in a doctor's office. But there are portable devices that can allow you to get treatment at home. Ask your doctor about it.

Sometimes, doctors use light therapy along with a substance called psoralen. You would take psoralen by mouth or as an ointment, then get light therapy using UVA light. While this therapy is effective, it's much more difficult to give than regular phototherapy.

Depigmentation. If other treatments haven't worked and your vitiligo covers a lot of your body, your doctor may recommend a procedure called depigmentation. A substance goes on the unaffected areas of your skin once or twice a day for about 9 months. Gradually, that skin will permanently lighten so that it matches the rest of your skin.

Side effects can include:

  • Swelling
  • Redness
  • Itching
  • Dry skin

Talk to your doctor about which of these treatments might be right for you.

Alternative medicine for vitiligo

A few studies suggest that ginkgo biloba can give you some of your skin color back.

Cucumis melo may help by stopping the breakdown of melanocytes, which can potentially restore some color to your skin and prevent the spread of vitiligo to other areas.

Khelin, which helps the melanocytes grow, can help repigment the skin.

Green tea, known for its anti-inflammatory, antioxidant, and immunomodulatory properties, may help manage oxidative stress that leads to the death of melanocytes.

Because of its anti-inflammatory and antioxidant properties, capsaicin in chili peppers may help treat vitiligo.

Some experts also say some supplements can help phototherapy be more effective, including:

  • Alpha-lipoic acid
  • Folic acid
  • Vitamin C
  • Vitamin B12

Be sure to talk with your doctor before you take any supplements. They could affect any medicines you're already taking.

Surgery for vitiligo

If other treatments haven't worked for you, your doctor may recommend surgery. The goal of these procedures is to even out the tone of your skin.

Skin grafting is where a surgeon transfers healthy portions of your skin to the discolored areas. Your doctor might suggest this if you have small patches of vitiligo.

In blister grafting, your surgeon will use suction to create blisters on your healthy skin, then move the top of those blisters to your discolored skin.

A cellular suspension transplant is when your doctor takes tissues from your healthy skin, puts them into a solution, and moves them onto your discolored skin. Results of this may take weeks to show up.

Your doctor will let you know if one of these procedures can help you. But they might not recommend surgery if you are prone to having scars or keloids.

Surgery may be a good option for you if you:

  • Have segmental vitiligo
  • Have focal vitiligo in a small area
  • Have vitiligo in parts where color doesn't easily come back, such as the hairline, forehead, and ankles

There are some things you can do at home to protect your skin and help improve its appearance:

  • Cover the affected skin with makeup or tanning products.
  • Use sunscreen (with at least SPF 30) when you’re outside, and reapply it every 2 hours.
  • Stay away from tanning beds.
  • Don't get tattoos. The damage they do to your skin can cause more vitiligo.

If you have vitiligo, you may be more likely to get:

  • Sunburn
  • Eye issues
  • Hearing loss

The changes in your appearance can also make you feel down, stressed, or self-conscious. A lot of things can help, including:

  • Talking about it with friends and family
  • Finding a support group, either in person or online, so you can talk with people going through the same things you are
  • Seeing a doctor who knows a lot about the condition so they can find the best treatment and help for you

Be sure to tell your doctor if you feel depressed. They can recommend a mental health professional who can help you feel better.

It’s impossible to prevent vitiligo. But see a dermatologist as soon as you start noticing symptoms on your skin, such as milky-white patches. They can tell you if it’s vitiligo or some other skin condition and treat it accordingly. The sooner they treat the vitiligo, the easier it is to treat and better your treatment result.

Protecting your skin from the sun is the best way to prevent vitiligo from spreading. The skin with vitiligo is prone to sunburn, which can make the condition worse.

You can protect your skin from the sun by:

  • Staying under a shade when outdoor
  • Wearing clothes that protect you from the sun
  • Wearing a water-resistant sunscreen with broad-spectrum protection and an SPF of 30 or higher on skin not covered by clothing
  • Avoiding tanning

Vitiligo causes areas of your skin to become milky white. This condition may last long, and treatment may not completely reverse your skin to its original color. If you notice any white patches on your skin, see a dermatologist as soon as possible to know the cause and start treatment. Also, see a doctor if you start having other physical and mental health symptoms with your vitiligo. In the meantime, always protect your skin from the sun whether or not you have vitiligo.

Can vitiligo go away?

No, vitiligo won’t go away, but treatment can stop it from spreading and may help bring back some of your skin’s color.

What makes vitiligo worse?

Sun exposure and sunburn can make vitiligo worse.

Is vitiligo contagious?

Vitiligo isn’t contagious, but it may run in families.