Vitiligo: What We Know and What We Don’t Know
Vitiligo is an autoimmune disease characterized by a loss of pigment (color) in the skin, resulting in lighter spots or patches that may gradually expand. While it commonly affects a person’s face, hands, arms, feet, and legs, vitiligo patches can also appear anywhere else in the body.
How Does Vitiligo Develop?
Cameron Coury, MD, a dermatologist at Dermatologist Specialists in Richardson, TX, mentions that vitiligo often begins on areas of the face. “Vitiligo can start as one small light patch, or as several patches around eyes, nose, or mouth,” she says.
Vitiligo arises when melanocytes, the cells that produce melanin, die and no longer produce melanin, the substance that gives the skin, hair, and eyes their typical color.
Hannah Kopelman, MD, a dermatologist at Kopelman Aesthetic Surgery, mentions the role of the immune system in killing these cells. “While we know that this occurs due to the immune system attacking melanocytes—the cells responsible for producing skin pigment—there’s still much we don’t fully understand about why this happens in the first place,“ she explains.
The causes of vitiligo are unknown, but a family history may increase a person’s risk of developing the condition. Other risk factors include severe sunburn, chemical burns, and injury (1). “We also see vitiligo in areas of trauma – so the back of the hands, feet, and knees are also common spots,” notes Dr. Coury.
What are the Clinical Manifestations of Vitiligo?
The way vitiligo presents itself can differ from one person to another. “The clinical manifestations vary widely, not just in terms of the extent of skin involvement but also in the way it progresses,” Dr. Kopeland says. “Some patients experience a rapid spread, while others may have long periods where the condition remains stable,” she adds.
Additional signs and symptoms may include itchiness in the discolored skin areas, eye and hair color changes, and even hearing loss.
There are Different Types of Vitiligo:
Localized: Skin spots or patches are scattered in limited areas of the body, such as the hands and face.
Generalized: Spots or patches appear throughout multiple areas of the body.
Segmental: Spots and patches appear on one side of the body. This type is unique because it typically affects only one side of the body, without crossing the midline on either the front or back.
Non-segmental: Spots and patches are on both sides of the body, such as both hands or both feet.
Mucosal: Patches of pigment appear on mucosal surfaces, including the mouth, nose, or genitals.
Universal: In this widespread form of vitiligo, people lose most of their skin’s pigment.
Trichrome: Rare form with lesions that usually have three different shades: white, intermediate, and normal.
Confetti: Tiny spots appear in clusters.
What Populations Does Vitiligo Affect?
The contrast between skin shade and the patches that lose pigment is typically greater in people with darker skin types, yet people of any race, ethnicity, or skin color can develop vitiligo.
Many of the people who develop vitiligo start showing signs in childhood or by age 20 (2). Dr. Coury confirms that although the disease is common in children, the timing of its onset varies. “I frequently see vitiligo in children, but I have had some adult patients with new-onset vitiligo as well,” she notes.
How is Vitiligo Currently Treated? Can it be Reversed or Prevented?
Dr. Coury and Dr. Kopelman both discuss that while there is no cure for vitiligo, people can explore various treatments to help manage the spots and patches.
“Current treatments focus on managing symptoms and improving cosmetic appearance,” mentions Dr. Kopelman. “Options include topical corticosteroids, calcineurin inhibitors, and light therapy, such as narrowband UVB. More recent research is exploring the role of JAK inhibitors, which show promise in repigmenting the skin by interrupting the immune response that leads to depigmentation,” she adds.
A recent review highlighted Janus kinase inhibitors (JAK) as groundbreaking options for vitiligo treatment, with benefits noted when combined with light therapy (3).
“Procedures such as laser treatments or even transplanting cells from areas of the body that have normal pigmentation can be offered in dermatology centers that have a special focus on treating vitiligo as soon as spots appear,” says Dr. Coury.
Because the skin has lost its pigment, the lighter patches are especially susceptible to sunburn. Therefore, people with vitiligo should stay in the shade or shield the skin from sunlight using sunscreen and wearing hats and other protective clothing items. Makeup and self-tanners can also help mask the lighter spots or patches that appear on the face.
Treatments have been summarized in multiple review articles and guidelines, including practical recommendations for health care providers that were released in 2021 and published in The British Journal of Dermatology in 2022 (4).
There are no preventive measures against vitiligo, but people should visit a dermatologist’s office when lighter spots or discolored areas appear. “Because vitiligo is an autoimmune problem, there is not much a person can do to prevent the condition,” explains Dr. Coury.
What is Known and Unknown about Vitiligo?
Like many other autoimmune diseases, uncovering the causes and biological processes behind the development of vitiligo has been difficult.
People who have moles with halos around them, people with melanoma, and people who are receiving immunotherapy for melanoma appear to be more at risk of developing vitiligo (5). However, the reasons behind these connections are unknown. The link between vitiligo and melanoma has been discussed for decades because both normal and abnormal cancer cells express similar antigens (6). Research has shown that patients who are receiving immunotherapy for melanoma and develop vitiligo may have a better chance of surviving (6).
“Ongoing research is key to uncovering more about the underlying mechanisms of vitiligo and developing more effective treatments. The field is evolving, and I’m optimistic about the potential for new therapies that may offer better outcomes for those living with vitiligo,” says Dr. Kopelman.
How does Vitiligo affect People’s Psychological Health?
Because of its direct influence on appearance, vitiligo can affect a person’s self-esteem, leading to feelings of self-consciousness and frustration. A literature review highlighted relationships between vitiligo and anxiety, depression, sleep disturbances, and adjustment disorders (7).
“The psychological impact of vitiligo can’t be understated,” says Dr. Kopelman. “For many, it can lead to significant emotional distress, affecting self-esteem and quality of life. It’s crucial to approach treatment with empathy, considering both the physical and mental aspects of the condition,” she adds.
Dr. Coury stresses the importance of seeking support from specialized groups. “Support for people with vitiligo is also available through national research organizations”, she says.
Interdisciplinary treatment approaches that take medical, psychological, and social factors into consideration are essential for improving disease burden and patients’ quality of life (7, 8).
Read Monwabisi’s Story: Growing up with Vitiligo, Growing into Self-Acceptance
His experience sheds light on the challenges he faces, along with the resilience and strength he’s developed along the way.
What Can Those with Vitiligo Ask Their Doctor?
Every vitiligo situation is distinct, with different people displaying varying patch sizes and numbers across their bodies. People who have been diagnosed with vitiligo should seek out a dermatologist specialized in managing skin pigmentation disorders. This will ensure that they receive tailored care depending on their vitiligo type, individual needs, and other medical conditions, which is especially important when treating children (9).
Dr. Coury emphasizes that sharing concerns with a dermatologist is a crucial first step. “Patients should be direct about how vitiligo affects their life. They should ask for several different types of treatment and discuss their pros/cons in detail,” says Dr. Coury. “Sometimes, I even suggest body makeup that is also used to cover birthmarks and tattoos,” she adds.
About The Author
A freelance writer who specializes in medical and life science topics. As a trained researcher, she authored journal articles in the areas of infection and immunity and wrote booklets and book chapters about different diseases. As a professional communicator, she writes feature articles for magazines and other publications and develops content for higher education platforms. Damiana is also an experienced academic editor, microbiology educator, writing coach, and fragrance blogger. She is a contributing member of the American Medical Writers Association and a past-president of the association’s Southwest Chapter.
Sources
- Article Sources
American Academy of Dermatology. Vitiligo: Overview. https://www.aad.org/public/diseases/a-z/vitiligo-overview
Alikhan A. and colleagues. (2011). Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. Journal of the American Academy of Dermatology. 65(3):473-491. https://pubmed.ncbi.nlm.nih.gov/21839315/
Utama A. and colleagues. (2024). Janus kinase inhibitors and the changing landscape of vitiligo management: a scoping review. International Journal of Dermatology. 63(8):1020-1035. https://pubmed.ncbi.nlm.nih.gov/38610078/
Eleftheriadou V. and colleagues. (2022). British Association of Dermatologists guidelines for the management of people with vitiligo 2021. British Journal of Dermatology. 186(1):18-29. https://pubmed.ncbi.nlm.nih.gov/34160061/
American Academy of Dermatology. Vitiligo: Causes. https://www.aad.org/public/diseases/a-z/vitiligo-causes
Failla C.M. and colleagues (2019). Melanoma and vitiligo: In good company. International Journal of Molecular Science. 20(22):5731. https://pubmed.ncbi.nlm.nih.gov/31731645/
Ezzedine K. and colleagues. (2021). Psychosocial Effects of Vitiligo: A Systematic Literature Review. American Journal of Clinical Dermatology. 22(6):757-774. https://pubmed.ncbi.nlm.nih.gov/34554406/
Eleftheriadou V. (2023). Skin is a window into one’s inner world. British Journal of Dermatology. 189(5):501-502. https://pubmed.ncbi.nlm.nih.gov/37624845/
American Academy of Dermatology. Vitiligo: Diagnosis and Treatment. https://www.aad.org/public/diseases/a-z/vitiligo-treatment
