Woman's back before a mole removal procedure at Saguaro Dermatology - Phoenix Dermatologist


Vitiligo (pronounced vit-ih-LIE-go) is a chronic, persistent skin disease that causes sharply delineated patches of your skin to lose color and turn white. It can also drain color from the hair on your face and scalp as well as your eyebrows and eyelashes. You might have heard of vitiligo in connection with Michael Jackson, whose very public struggle with this skin condition brought attention to it in the 1980s.

An estimated 2% of the global population has vitiligo, and half of all cases appear before the age of 20 (1). However, regardless of when you experience the first signs of the condition, it tends to reach its peak in the second or third decade after onset. Moreover, vitiligo affects people of all skin types and races, as well as both males and females.

Vitiligo by itself is not associated with other health issues, but because it typically presents on the face and neck, it can have a devastating impact on body image and self-confidence. It can also raise other concerns about appearance and ethnic identity. This may be particularly true in people with darker skin because the loss of color is more noticeable.

If you have vitiligo, your main concern will be what you can do to get rid of it or at least minimize it. But before we get to those points, it’s helpful to understand what vitiligo is and what causes it.

The most common form of vitiligo is known as generalized or non-segmental vitiligo. If you have this form of the condition, you will generally see whitish patches of skin all over your body, in particular on your face, neck, and scalp but also around your mouth, genitals, and other body openings. In a mucosal form of non-segmental vitiligo, your lips and other mucous membranes (such as those in your nose) may lose color. Another form called acrofacial vitiligo affects your face, hands, and feet. Non-segmental vitiligo develops over a long period of time and accounts for 85-90% of all cases of the condition (1).

Segmental vitiligo accounts for the other 10-15% of vitiligo cases (1). This form of vitiligo often appears earlier and stabilizes in a few months. With segmental vitiligo, the colorless skin patches are generally smaller and restricted to a defined area on one side of your body.

Vitiligo is a disease of the skin that affects the cells that produce melanin, the natural chemical that gives color to your eyes, hair, and skin. These cells are called melanocytes. Researchers believe that vitiligo may be an autoimmune disorder that causes your body’s immune system to attack and destroy these skin cells (1).

As with other autoimmune diseases, such as psoriasis, vitiligo can run in families, and people with vitiligo often have a family member who also has the disease or who has another autoimmune disorder. In fact, vitiligo is associated with several other autoimmune conditions, including thyroid disease, alopecia areata, inflammatory bowel disease, pernicious anemia, and others. In one study of 1098 patients with vitiligo, almost 20% had at least one other autoimmune condition (2).

Of course, many patients with vitiligo have neither a family connection nor another auto-immune disorder. For example, in a study using identical twins, vitiligo was present in both twins in only 23% of the pairs investigated (1). So, while autoimmunity is the most understood cause of vitiligo, other explanations have also been investigated: An accumulation of toxic compounds in your system may lead to cell death (cytotoxicity) of melanocytes; nerve injury may cause neurons to have a cytotoxic (cell-killing) effect on the melanocytes; or infection, stress, or a combination of events may provide the perfect environment for the disease (3). You can’t rule out simple environmental factors either, such as exposure to a chemical or even sunburn.

Can Vitiligo Be Cured?

Because a clear cause for vitiligo cannot be identified, a treatment to cure it does not yet exist. However, there are more treatments available today than ever before. Let’s look at some of the most common therapies now available.

What Is the Best Treatment for Vitiligo?

Current treatments for vitiligo include nonsurgical and surgical approaches, and both focus on two clear goals: 1) stopping the disease from getting worse and 2) bringing color back to the affected patches of skin (3). Achieving these outcomes involves either stimulating the growth of more melanocytes (those cells that produce the color) or interfering with the mechanism that destroys the melanocytes, thus allowing them to function properly. Here we’ll look primarily at some nonsurgical approaches.

Nonsurgical Repigmentation Treatments

Bringing color back to the affected skin is called repigmentation. Nonsurgical approaches to repigmentation include medications, i.e., topical corticosteroids or immunomodulators, and photo(chemo)therapy (PUVA). Following is a brief description of these therapies.

Traditionally, two topical steroids, 0.I% betamethasone valerate and 0.05% clobetasol propionate creams, have been successful at bringing some color back to depigmented skin. More recently, clobetasol, tacrolimus, and catalase/dismutase superoxide (C/DSO) have achieved positive results (3).
These are medicines that help your immune system function properly. Specifically, they inhibit the action of calcineurin, an enzyme that activates T-cells of the immune system. There are two types of topical calcineurin inhibitors, tacrolimus ointment and pimecrolimus cream.
These are synthesized drugs that work by increasing vitamin D levels in your body and helping it to absorb more calcium. This is important because vitamin D is an essential hormone synthesized in the skin and is responsible for skin pigmentation. Low levels of vitamin D have been observed in vitiligo patients and in patients with other autoimmune diseases (4). Topical calcipotriol is a vitamin D analogue that appears to be an effective treatment for vitiligo and can be safely used in combination with PUVA.
PUVA is a treatment that combines ultraviolet (UV) radiation treatment (phototherapy) with a compound in plants called psoralens. In cases of widespread vitiligo, psoralens are taken orally before the affected parts of your body are exposed to UV lamps. If only small areas of skin are treated, psoralens may be applied in the form of a gel or cream.

Surgical Repigmentation Therapy

There are a number of surgical therapies, all of which are complicated and used only after other therapies fail (3). The basic principle of repigmentation surgery involves transplanting melanocytes from pigmented skin to affected areas of skin with no melanocytes. The success of this kind of surgery depends on many factors, such as the area of skin receiving the transplant and the stability of the disease, so doctors select candidates for surgical repigmentation very carefully.

Other Therapies

When therapies to restore color to the skin fail, a kind of reverse treatment can be done. Depigmentation therapy refers to a method of removing color from the skin that is not affected by vitiligo (3) to create a uniform skin tone. Using a “bleaching” agent called monobenzylether of hydroquinone, this therapy is performed only if more that 60 or 80% of the skin on your face or body is affected.

Finally, while combination treatments for vitiligo have been used for several decades, a new combination therapy has been reported that promises dramatic results. Testing has been limited, and findings will need to be duplicated. Still, this “breakthrough” treatment is just one example of the ongoing efforts to provide relief for individuals affected by this most visible of skin diseases.

What Else Can I Do to Manage My Vitiligo?

Although there is no cure for vitiligo, there are ways to minimize its impact on your life. The American Academy of Dermatology offers these tips:

  • Protect your skin from the sun with sunscreen and protective clothing
  • Seek shade
  • Refrain from using tanning beds and sun lamps
  • Use a self-tanner, concealing cream, dye or makeup to add color to your skin
  • Do not get a tattoo<
  • Learn more about possible options for treatment
  • Find a support group or connect with others who have vitiligo

Final Word on Vitiligo

Like other visible skin diseases, vitiligo can seriously erode your quality of life. The first step in taking back control is to speak with a caring and knowledgeable professional. Armed with more knowledge about your condition, you will have a clearer picture of the possibilities for treatment and be able to make better choices regarding your care. For more information, our board-certified dermatologists and the caring staff at Saguaro Dermatology are here to help.

Suggested Readings
Vitiligo, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH). https://www.niams.nih.gov/health-topics/vitiligo
Vitiligo, Genetics Home Reference, National Institutes of Health (NIH), U.S. National Library of Medicine. https://ghr.nlm.nih.gov/condition/vitiligo
Vitiligo: Overview, American Academy of Dermatology Association. https://www.aad.org/public/diseases/a-z/vitiligo-overview
1. Singh, RK (2017). “Impact of Ultraviolet Light on Vitiligo.” Advances in experimental medicine and biology (0065-2598), 996 , p. 55.
2. Gill L, Zarbo A, Isedeh P, et al. Comorbid autoimmune diseases in patients with vitiligo: a cross-sectional study. J Am Acad Dermatol 2016;74(2):295-302.
3. Borderé AC, Lambert J, van Geel N. Current and emerging therapy for the management of vitiligo. Clin Cosmet Investig Dermatol 2009;2:15-25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047938/
4. AlGhamdi K, Kumar A, Moussa N. The role of vitamin D in melanogenesis with an emphasis on vitiligo. Indian J Dermatol Venereol Leprol 2013;79(6):750-758.

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About Saguaro Dermatology

Our comprehensive dermatology clinic is dedicated to providing you with the highest quality of care, innovative practices, helpful resources and state-of-the-art technology to prevent and treat a multitude of skin disorders. Led by Carsten R. Hamann, MD, PhD, Dathan Hamann, MD, FAAD, Michael McBride, DO, Millard Thaler, MD, Mohs Surgeon and Jenna Wald, MD, Mohs Surgeon, our passionate team looks forward to serving you with respect and compassion.

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