Well-demarcated depigmented patches of the skin may be difficult to hide, especially if present on the face or hands - but vitiligo is not merely a cosmetic problem. It is an autoimmune skin disorder in which the immune system identifies the pigment producing cells, called melanocytes, as foreign and targets them for destruction. As a result, the affected melanocytes stop producing melanin, leading to whitening of the skin. These patches can occur anywhere on the body, but are most frequently found on the face, hands, arm pits, and genitals. The loss of pigment in vitiligo may also affect the hair and mucous membranes.
While the skin disease has gained awareness in recent years, vitiligo is still misunderstood and often leads to isolation of affected people. As with other autoimmune disorders, the initial cause for autoimmunity is still unknown. 1% of the world's population including people of any age, gender, or ethnicity are affected.
The diagnosis of vitiligo is made based on the clinical appearance of the skin lesions. A special lamp emitting black light may be used to identify tiny patches. Additional tests, such as skin biopsies, may be performed to rule out other skin conditions. Depending on the affected area, different types can be distinguished:
Non-segmental/generalized vitiligo: This is the most common type of vitiligo, which affects both sides of the body symmetrically. The patches may start small and then grow larger over time. This subtype usually imposes a favorable treatment response.
Segmental vitiligo: This type of vitiligo only affects one side of the body. It tends to appear in childhood or early adolescence and may stop spreading after a few years. Single patches may be resistant to treatment attempts.
Although there is no cure for vitiligo and the effectiveness of treatment varies depending on the individual case, the extent and progression speed of the condition, treatment options are available to help restore pigmentation to the affected areas of skin. Conventional options include anti-inflammatory topical corticosteroids and calcineurin inhibitors, potentially combined with light therapy. These treatments are effective when vitiligo is still at an early stage. Recently, new therapies have been approved by the FDA including JAK inhibitors, showing promising effects regarding repigmentation. Surgical intervention may be performed in stable vitiligo and small patches.
What’s important to know if you are suffering from vitiligo:
1. Consult a board-certified dermatologist to confirm the diagnosis
2. Perform a laboratory test including thyroid levels to uncover possible adjacent autoimmune diseases
3. Protect your skin from the sun and use broad-spectrum SPF 50 since the pale patches lack melanin and are more susceptible to sunburn, although recent data suggest that there is no increased risk of skin cancer in vitiligo patients
4. There is no cure, but several effective treatments are currently emerging
5. Review your family medical history to find out if anyone in your family had vitiligo
6. Never feel isolated by its appearance. Confront people openly and spread awareness!
7. It is not contagious and free of symptoms such as itching or burning
8. Be patient. You may have to try more than one treatment approach or a combination before you find the treatment that works best for you
Bergqvist C, Ezzedine K. Vitiligo: A focus on pathogenesis and its therapeutic implications. J Dermatol 2021; 48: 252-270
Phan K, Phan S, Shumack S, Gupta M. Repigmentation in vitiligo using janus kinase (JAK) inhibitors with phototherapy: systematic review and Meta-analysis. J Dermatolog Treat 2022; 33: 173-177
Bohm M, Schunter JA, Fritz K et al. S1 Guideline: Diagnosis and therapy of vitiligo. J Dtsch Dermatol Ges 2022; 20: 365-378
Ezzedine K, Eleftheriadou V, Jones H et al. Psychosocial Effects of Vitiligo: A Systematic Literature Review. Am J Clin Dermatol 2021; 22: 757-774
Hamzavi I, Rosmarin D, Harris JE et al. Efficacy of ruxolitinib cream in vitiligo by patient characteristics and affected body areas: Descriptive subgroup analyses from a phase 2, randomized, double-blind trial. J Am Acad Dermatol 2022; 86: 1398-1401