Buy the Book

Print This Topic Email This Topic

Pronunciations corticosteroid melanin melanocytes melasma psoralens

Vitiligo is a disorder in which a localized loss of melanocytes causes patches of skin to turn white.

• Patches of whitened skin are present on various parts of the body.
• Doctors usually base the diagnosis on the appearance of the skin.
• Corticosteroid creams or phototherapy plus light-sensitizing drugs may darken the skin, or, if needed, skin grafts may be used.

The cause of vitiligo is unknown, but it may involve an attack by the immune system on the cells that produce the skin pigment melanin (melanocytes). Vitiligo tends to run in families and may occur with certain other diseases. Vitiligo is associated with autoimmune disorders, thyroid disease being the most common. The relationship between the disorders is unclear; however, people with diabetes, Addison's disease, and pernicious anemia also are somewhat more likely to develop vitiligo. The disorder may occur after physical trauma or sunburn.

Although vitiligo does not pose a medical problem, it may cause considerable psychologic distress.

Symptoms and Diagnosis

In some people, one or two well-defined patches of vitiligo appear. In other people, patches appear over a large part of the body. The changes are most striking in people with dark skin. Commonly affected areas are the face, elbows, knees, hands, shins, and genitals. The affected skin is extremely prone to sunburn. The areas of skin affected by vitiligo also produce white hair because melanocytes are lost from the hair follicles.

Vitiligo is recognized by its typical appearance. A Wood's light examination is often done to help distinguish vitiligo from other causes of lightened skin (see Diagnosis and Treatment of Skin Disorders: Diagnosis). Other tests, including skin biopsies, are rarely necessary.

Vitiligo

Treatment

No cure is known for vitiligo, although skin color may return spontaneously. Treatment may be helpful. Small patches sometimes darken when treated with strong corticosteroid creams. Drugs such as tacrolimus Some Trade Names
PROGRAF
or pimecrolimus may be applied to the face, where strong corticosteroid creams may cause side effects. Some people simply use bronzers, skin stains, or makeup to darken the area. Because many people still have a few melanocytes in the patches of vitiligo, exposure to ultraviolet (UV) light in a doctor's office (phototherapy) restimulates pigment production in more than half of them (see Phototherapy: Using Ultraviolet Light to Treat Skin Disorders). In particular, psoralens (drugs that make the skin more sensitive to light) combined with ultraviolet A light (PUVA) or narrow-band ultraviolet B light treatment without psoralens can be given. However, phototherapy takes months to be effective and may need to be continued indefinitely.

Areas that do not respond to phototherapy may be treated with various skin-grafting techniques and even transplantation of melanocytes grown from unaffected areas of the person's skin. All affected areas of skin should be protected from the sun with clothing and sunscreen.

Some people who have very large areas of vitiligo sometimes prefer to bleach the pigment out of the unaffected skin to achieve an even color. Bleaching is done with repeated applications of hydroquinone cream to the skin for weeks to years. The effects of bleaching are irreversible.

Last full review/revision October 2008 by Daniel E. McGinley-Smith, MD