Vitiligo (‘White’ Skin Disease) – Causes, Symptoms, Treatment

Vitiligo is a skin disorder that causes hypopigmented patches on the skin. The skin pigment, melanin, is deficient in these areas making the skin look white to light brown. It can affect only certain areas or it can be spread out through many areas in the body. Vitiligo should not be confused with albinism (albino skin) where melanin production is impaired and the entire body is affected from birth.

Other skin conditions may sometimes be confused with vitiligo. A yeast infection (skin fungus) known as pityriasis versicolor can affect the back, chest and face. This condition can be treated with antifungals. Pityriasis alba is form of eczema seen in children where the affected skin is pale in color. Vitiligo should also not be confused with leprosy,  although the latter also cause hypopigmentation of the skin – vitiligo and leprosy are two separate diseases.

Causes of Vitiligo

The exact cause of vitiligo is unknown. It is believed that the body’s immune cells, which are supposed to protect the body against foreign invaders, start to attack the melanocytes (pigment producing cells). This affects the melanocytes ability to produce the normal skin pigment. Depending on the severity of the disease, the melanin (skin pigment) production is initially low thereby making the skin patches appear lighter than the normal skin. With time this progresses and the light coloured patches become deficient of pigment and the skin looks white.

Vitiligo is not contagious. There seems to be a family history of vitiligo, especially when there is a genetic predisposition to developing certain types of autoimmune diseases like diabetes, blood and thyroid disorders. Severe sunburn, certain drugs and chemicals and injury to the skin may trigger the onset of vitiligo but it is unlikely that these factors actually cause the condition.

Vitiligo affects both and men of all races but it is more noticeable in darker skinned individuals. Women are more likely to report vitiligo even in areas that are concealed but men are equally likely to develop this skin condition.

There is no significant evidence to suggest that skin lightening creams (skin whiteners) may trigger vitiligo but these creams are dangerous and can cause severe hypopigmentation of the skin followed by hyperpigmentation (darkening).

Signs and Symptoms of Vitiligo

Vitiligo is not an itchy skin disease. Most vitiligo sufferers will not experience any uncomfortable sensation on the problems areas. However, the lack of pigment means that these areas are more sensitive to the sun and vitiligo sufferers may experience itching, burning and redness on the affected area after prolonged exposure to the sun.

White patches of skin are the defining feature of vitiligo. It may start as small dots, about the size of a pinhead, and it gradually grows. The skin patches are not of a specific shape – they may be odd in shape and vary in size. If it affects the area where hair is growing, it can also affect the normal colour of the hair.

Vitiligo patches may clear on their own without any treatment but can recur. These patches are usually slow growing and can grow over months and years.

Treatment of Vitiligo

Vitiligo is a difficult condition to treat and manage. There is no cure. Many doctors start with strong steroid creams (topical corticosteroids) but this may only offer short term relief. Even if the patch disappears at one site, it is likely to  recur or develop elsewhere.

Ultraviolet therapy may be of some use – psoralens and PUVA treatment, which is mainly used for treating psoriasis, does offer some promising results. Ultraviolet B (UVB) also can provide some assistance but like most of the other treatment options, the results may be short lived.

Most vitiligo sufferers learn to live with the condition and use cosmetics to hide the patches. Using a sunblock on the affected area is very important – the lack of pigment on these patches means it is more prone to sun damage and there may also be an increased risk of skin cancer.