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October 2016

Questions and Answers about

Vitiligo

This publication contains general information

about vitiligo. Individual sections describe

what vitiligo is, who is affected, its symptoms,

how it is diagnosed, and treatment options. If

you have further questions, you may wish to

discuss them with your health care provider.

What is vitiligo?

Vitiligo (vit-ill-EYE-go) is a pigmentation

disorder in which melanocytes (the cells that

make pigment) in the skin are destroyed. As a

result, white patches appear on the skin in

different parts of the body. Similar patches

also appear on both the mucous membranes

(tissues that line the inside of the mouth and

nose) and the retina (inner layer of the

eyeball). The hair that grows on areas

affected by vitiligo sometimes turns white.

The cause of vitiligo is not known, but

doctors and researchers have several

different theories. There is strong evidence

that people with vitiligo inherit genes that

make them susceptible to depigmentation.

The most widely accepted view is that the

depigmentation occurs because vitiligo is an

autoimmune disease – a disease in which a

person's immune system reacts against the

body's own organs or tissues. People's

bodies produce proteins called cytokines

that, in vitiligo, alter their pigment-producing

cells and cause these cells to die. Another

theory is that melanocytes destroy

themselves. Finally, some people have

reported that a single event, such as sunburn

or emotional distress, triggered vitiligo;

however, these events have not been

scientifically proven as causes of vitiligo.

Who is affected by vitiligo?

What are the symptoms of vitiligo?

Will the depigmented patches

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spread?

How is vitiligo diagnosed?

How can people cope with the

emotional and psychological aspects

of vitiligo?

What treatment options are available?

What research is being conducted on

vitiligo?

Where can people find more

information about vitiligo?

Who is affected by vitiligo?

About 0.5 to 1 percent of the world’s

population have vitiligo. The average age of

onset is in the mid-twenties, but it can appear

at any age. The disorder affects both sexes

and all races equally; however, it is more

noticeable in people with dark skin.

Vitiligo seems to be somewhat more common

in people with certain autoimmune diseases,

including hyperthyroidism (an overactive

thyroid gland), adrenocortical insufficiency

(the adrenal gland does not produce enough

of the hormone called corticosteroid),

alopecia areata (patches of baldness), and

pernicious anemia (a low level of red blood

cells caused by the failure of the body to

absorb vitamin B12). Scientists do not know

the reason for the association between

vitiligo and these autoimmune diseases.

However, most people with vitiligo have no

other autoimmune disease.

Vitiligo sometimes runs in families. Children

whose parents have the disorder are more

likely to develop vitiligo. However, most

children will not get vitiligo even if a parent

has it, and most people with vitiligo do not

have a family history of the disorder.

What are the symptoms of vitiligo?

People who develop vitiligo usually first

notice white patches (depigmentation) on

their skin. These patches are more commonly

found on sun-exposed areas of the body,

including the hands, feet, arms, face, and

lips. Other common areas for white patches

to appear are the armpits and groin and

around the mouth, eyes, nostrils, navel,

genitals, and rectum.

Vitiligo generally appears in one of two

patterns:

Questions and Answers about Vitiligo https://www.niams.nih.gov/health_info/vitiligo/

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Segmental (or unilateral) pattern –

depigmented patches that develop on

one side of the body only.

Nonsegmental (or bilateral or

generalized) pattern – the most

common pattern. Depigmentation

occurs symmetrically on both sides of

the body.

In addition to white patches on the skin,

people with vitiligo may have premature

graying of the scalp hair, eyelashes,

eyebrows, and beard. People with dark skin

may notice a loss of color inside their mouths.

Will the depigmented patches

spread?

Segmental vitiligo remains localized to one

part of the body and does not spread. There

is no way to predict if nonsegmental vitiligo

will spread. For some people, the

depigmented patches do not spread. The

disorder is usually progressive, however, and

over time the white patches will spread to

other areas of the body. For some people,

vitiligo spreads slowly, over many years. For

other people, spreading occurs rapidly. Some

people have reported additional

depigmentation following periods of physical

or emotional stress.

How is vitiligo diagnosed?

The diagnosis of vitiligo is made based on a

physical examination, medical history, and

laboratory tests.

A doctor will likely suspect vitiligo if you report

(or the physical examination reveals) white

patches of skin on the body, particularly on

sun-exposed areas, including the hands, feet,

arms, face, and lips. If vitiligo is suspected,

the doctor will ask about your medical history.

Important factors in the diagnosis include a

family history of vitiligo; a rash, sunburn, or

other skin trauma that occurred at the site of

vitiligo before depigmentation started; stress

or physical illness; and premature graying of

the hair (usually before age 35). In addition,

the doctor will ask whether you or anyone in

your family has had any autoimmune

diseases and whether you are very sensitive

to the sun.

To help confirm the diagnosis, the doctor may

take a small sample (biopsy) of the affected

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skin to examine under a microscope. In

vitiligo, the skin sample will usually show a

complete absence of pigment-producing

melanocytes. On the other hand, the

presence of inflamed cells in the sample may

suggest that another condition is responsible

for the loss of pigmentation.

Because vitiligo may be associated with

pernicious anemia (a condition in which an

insufficient amount of vitamin B12 is absorbed

from the gastrointestinal tract) or

hyperthyroidism (an overactive thyroid gland),

the doctor may also take a blood sample to

check the blood cell count and thyroid

function. For some patients, the doctor may

recommend an eye examination to check for

uveitis (inflammation of part of the eye),

which sometimes occurs with vitiligo. A blood

test to look for the presence of antinuclear

antibodies (a type of autoantibody) may also

be done. This test helps determine if the

patient has another autoimmune disease.

How can people cope with the

emotional and psychological

aspects of vitiligo?

Although vitiligo is usually not harmful

medically, its emotional and psychological

effects can be devastating.

White patches of vitiligo can affect emotional

and psychological well-being and

self-esteem. People with vitiligo can

experience emotional stress, particularly if the

condition develops on visible areas of the

body (such as the face, hands, arms, and

feet) or on the genitals. Adolescents, who are

often particularly concerned about their

appearance, can be devastated by

widespread vitiligo. Some people who have

vitiligo feel embarrassed, ashamed,

depressed, or worried about how others will

react.

Fortunately, there are several strategies to

help people cope with vitiligo. Also, various

treatments – discussed in the next section –

can minimize, camouflage, or, in some cases,

even eliminate white patches. First, it is

important to find a doctor who is

knowledgeable about the disorder and takes

it seriously. You must let your doctor know if

you are feeling depressed, because doctors

and other mental health professionals can

help people deal with depression. You should

also learn as much as possible about the

Questions and Answers about Vitiligo https://www.niams.nih.gov/health_info/vitiligo/

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disorder and treatment choices so that you

can participate in making important decisions

about your medical care.

What treatment options are

available?

The main goal of treating vitiligo is to reduce

the contrast in color between affected and

unaffected skin. The choice of therapy

depends on the number of white patches;

their location, sizes, and how widespread

they are; and what you prefer in terms of

treatment. Each patient responds differently

to therapy, and a particular treatment may not

work for everyone. Current treatment options

for vitiligo include medication, surgery, and

adjunctive therapies (used along with surgical

or medical treatments).

Medical Therapies

A number of medical therapies, most of which

are applied topically, can reduce the

appearance of vitiligo. These are some of the

most commonly used:

Topical therapy. Creams, including

corticosteroids, may be helpful in

repigmenting (returning the color to)

white patches, particularly if they are

applied in the initial stages of the

disease. Corticosteroids are a group

of drugs similar to hormones such as

cortisone, which are produced by the

adrenal glands. Yet, as with any

medication, these creams can cause

side effects. For this reason, the

doctor will monitor you closely for skin

shrinkage and skin striae (streaks or

lines on the skin).

Light treatment. Light therapy or

excimer laser treatments are also

used to treat vitiligo, although multiple

treatments are needed and results

may not be permanent.

Psoralen photochemotherapy. Also

known as psoralen and ultraviolet A

(PUVA) therapy, this is an effective

treatment for many patients. The goal

of PUVA therapy is to repigment the

white patches. However, it is time

consuming, and care must be taken to

avoid side effects, which can

sometimes be severe. Psoralen is a

drug that contains chemicals that

Questions and Answers about Vitiligo https://www.niams.nih.gov/health_info/vitiligo/

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react with ultraviolet light to cause

darkening of the skin. The treatment

involves taking psoralen by mouth

(orally) or applying it to the skin

(topically). This is followed by

carefully timed exposure to sunlight or

to ultraviolet A (UVA) light that comes

from a special lamp. You must

minimize exposure to sunlight at other

times.

Known side effects of oral psoralen

include sunburn, nausea and

vomiting, itching, abnormal hair

growth, and hyperpigmentation. Oral

psoralen photochemotherapy may

also increase the risk of skin cancer,

although the risk is minimal at doses

used for vitiligo. If you are undergoing

oral PUVA therapy, you will be

advised to apply sunscreen, avoid

direct sunlight, and wear protective

UVA sunglasses for a period of time

after each treatment.

Depigmentation. This treatment

involves fading the rest of the skin on

the body to match the areas that are

already white. For people who have

vitiligo on more than 50 percent of

their bodies, depigmentation may be

recommended. Patients apply cream

once or twice a day to pigmented

areas until they match the already

depigmented areas. The major side

effect of depigmentation therapy is

inflammation (redness and swelling)

of the skin. You may also experience

itching or dry skin. Depigmentation

tends to be permanent, is time

consuming, and is not easily

reversed. In addition, a person who

undergoes depigmentation will always

be unusually sensitive to sunlight.

Surgical Therapies

Surgical techniques may be an option when

topical creams and light therapy do not work.

Surgery is typically not recommended for

people who scar easily or develop keloids. A

variety of effective procedures are available.

Talk to your doctor about whether a surgical

approach may be right for you.

Additional Therapies

In addition to medical and surgical therapies,

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there are many things you can do on your

own to protect your skin, minimize the

appearance of white patches, and cope with

the emotional aspects of vitiligo:

Sunscreens. People who have

vitiligo, particularly those with fair

skin, should minimize sun exposure

and use a sunscreen that provides

protection from both UVA and

ultraviolet B light. Tanning makes the

contrast between normal and

depigmented skin more noticeable.

Sunscreen helps protect the skin from

sunburn and long-term damage.

Cosmetics. Some patients with

vitiligo cover depigmented patches

with makeup, self-tanning lotions or

dyes. These cosmetic products can

be particularly effective for people

whose vitiligo is limited to exposed

areas of the body.

Counseling and support groups.

Many people with vitiligo find it helpful

to get counseling from a mental health

professional. People often find they

can talk to a counselor about issues

that are difficult to discuss with

anyone else. A mental health

counselor can also offer support and

help in coping with vitiligo. In addition,

it may be helpful to attend a vitiligo

support group.

What research is being conducted

on vitiligo?

In the past, research on the role that

melanocytes play in vitiligo has greatly

increased. Genetic advances have permitted

relatively rapid increases in knowledge of

melanocytes at the cellular and molecular

levels.

Much of the research that holds promise for

understanding, treating, and possibly

preventing vitiligo is supported by the NIAMS.

Researchers are looking at the immune

response, in particular regulatory T cells, to

understand the body’s natural mechanisms to

control autoimmune diseases, which could be

used to develop new treatment strategies.

Others are trying to determine if melanocyte

stem cells are able to regenerate pigment in

skin where pigment has been lost.

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Melanocytes are also being studied to find

out the effects of ultraviolet light exposure on

immune responses to melanocytes. Still other

research is looking at melanocytes to find out

how specific enzymes manage to regulate the

melanin production. This understanding of

melanocytes may allow researchers to

stimulate the creation of melanocytes from

stem cells of hair follicles and use them to

add pigment back into affected skin. Such a

therapy may be more effective and safer than

current light therapies.

The NIAMS also supports studies looking for

genes that may contribute to vitiligo in several

ethnic groups. Genetic analyses of these

groups have enabled the identification of

several vitiligo susceptibility genes. This work

may lead to development of specific

approaches to disease therapy and

prevention for patients at high genetic risk.

More information on research is available

from the following resources:

National Institutes of Health (NIH)

Clinical Research Trials and You

was designed to help people learn

more about clinical trials, why they

matter, and how to participate. Visitors

to the website will find information

about the basics of participating in a

clinical trial, first-hand stories from

clinical trial volunteers, explanations

from researchers, and links on how to

search for a trial or enroll in a

research-matching program.

ClinicalTrials.gov offers up-to-date

information for locating federally and

privately supported clinical trials for a

wide range of diseases and

conditions.

NIH RePORTER is an electronic tool

that allows users to search a

repository of both intramural and

extramural NIH-funded research

projects from the past 25 years and

access publications (since 1985) and

patents resulting from NIH funding.

PubMed is a free service of the U.S.

National Library of Medicine that lets

you search millions of journal citations

and abstracts in the fields of

medicine, nursing, dentistry,

veterinary medicine, the health care

system, and preclinical sciences.

Questions and Answers about Vitiligo https://www.niams.nih.gov/health_info/vitiligo/

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Where can people find more

information about vitiligo?

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

If you need more information about available

resources in your language or another

language, please visit our website or contact

the NIAMS Information Clearinghouse at

NIAMSinfo@mail.nih.gov.

Other Resources

American Academy of Dermatology

Website: http://www.aad.org

American Vitiligo Research Foundation

Website: http://www.avrf.org

National Vitiligo Foundation, Inc.

Website: http://www.mynvfi.org

Vitiligo Support International Inc.

Website: http://www.vitiligosupport.org

Acknowledgments

The NIAMS gratefully acknowledges the

assistance of the following individuals in the

review of current and previous versions of

this publication: Alan Moshell, M.D.,

NIAMS/NIH; Jean-Claude Bystryn, M.D.,

New York University, New York, NY; Rebat

M. Halder, M.D., Howard University,

Washington, DC; James J. Nordlund, M.D.,

University of Cincinnati, Cincinnati, OH;

Group Health Associates of Cincinnati, OH.

The mission of the National Institute of

Arthritis and Musculoskeletal and Skin

Diseases (NIAMS), a part of the U.S.

Department of Health and Human Services'

National Institutes of Health (NIH), is to

support research into the causes, treatment,

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and prevention of arthritis and

musculoskeletal and skin diseases; the

training of basic and clinical scientists to

carry out this research; and the dissemination

of information on research progress in these

diseases. The NIAMS Information

Clearinghouse is a public service sponsored

by the Institute that provides health

information and information sources.

Additional information can be found on the

NIAMS website at http://www.niams.nih.gov.

For Your Information

This publication contains information about

medications used to treat the health condition

discussed here. When this publication was

developed, we included the most up-to-date

(accurate) information available.

Occasionally, new information on medication

is released.

For updates and for any questions about any

medications you are taking, please contact

U.S. Food and Drug Administration

Toll free: 888-INFO-FDA

(888-463-6332)

Website: http://www.fda.gov

For additional information on specific

medications, visit Drugs@FDA at

http://www.accessdata.fda.gov/scripts

/cder/daf/. Drugs@FDA is a searchable

catalog of FDA-approved drug products.

For updates and questions about statistics,

please contact

Centers for Disease Control and

Prevention, National Center for

Health Statistics

Toll free: 800-232-4636

Website: http://www.cdc.gov/nchs

This publication is not copyrighted. Readers

are encouraged to duplicate and distribute as

many copies as needed.

Additional copies of this publication are

available from:

National Institute of Arthritis and

Musculoskeletal and Skin

Diseases (NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

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Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS

(877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

NIH Publication No. 16-4998

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