Vitiligo is an autoimmune condition. The immune system attacks melanocytes, the cells that give skin its color, and patches of skin turn lighter, white or sometimes pink. It affects between 0.5% and 1% of people worldwide, at similar rates across ethnic groups, though it tends to be more noticeable on darker skin. It can start at any age, with an average age of onset in the mid-twenties. About one in five people with vitiligo has a close relative with it.
Vitiligo cannot be caught or passed on. It is not harmful to overall health, and it does not raise skin cancer risk. What it can do is change how a person looks and feels, and that part deserves real care too.
What it looks like and what affects it
Vitiligo often starts on the face, arms, hands or feet, then can appear anywhere, including the lips, the inside of the mouth and nose, and the genitals. Hair growing in a patch can turn white, including eyebrows, eyelashes or a streak of scalp hair.
There are two main patterns. Non-segmental vitiligo, the most common type, appears on both sides of the body and often spreads slowly over a lifetime. Segmental vitiligo, about 10% of cases, affects one side or one part of the body and usually stops spreading after 6 to 12 months. There is no reliable way to predict how far any one person’s vitiligo will go.
Possible triggers include stress, sunburn and certain chemicals. For some people, a skin injury, including a tattoo, sets off a new patch in that spot.
When to see a dermatologist
- New light or white patches, or hair turning white in a patch.
- Patches that are pink, itchy, or ringed by a band of tan skin. These can be signs that vitiligo is actively spreading.
- New patches appearing often.
- Vitiligo that is affecting how you feel about yourself or your life.
Seeing someone early matters: the sooner treatment starts, the more effective it tends to be.
What happens at the visit
A dermatologist asks about your history and family history and examines your skin. They may use a Wood’s lamp, a handheld ultraviolet light under which vitiligo patches look chalky and bright, which helps the dermatologist see every affected area. Because other conditions, such as tinea versicolor, can also cause light patches, getting the diagnosis right matters. Blood tests may be suggested to check for related autoimmune conditions, most often thyroid disease, since 15 to 25% of people with vitiligo have at least one other. Some people are also sent for an eye exam, and a skin biopsy is sometimes used.
How dermatologists treat it
Treatment cannot cure vitiligo. The goals are to bring back color, stop existing patches from growing, and prevent new ones. The plan depends on age, overall health, the type of vitiligo, where it is, whether it is spreading, and how much it affects your quality of life.
- Prescription creams and ointments. Short courses of corticosteroids, non-steroid creams that suit the face and neck, and a JAK inhibitor cream approved for non-segmental vitiligo from age 12. It was studied in people with smaller areas of affected skin, and that is how it is used. In clinical trials, about 30% of people using it got back 75% of their color by week 24.
- Light therapy. Ultraviolet light from a light box for larger areas, or a targeted laser for small ones. It works best on the face and neck and is sometimes combined with creams.
- Oral medicine. A short course of corticosteroid pills may be selected when new spots are appearing quickly.
- Surgery. Skin grafts or cell transplants for patches that have not responded to other treatment, usually once vitiligo has been stable for at least 12 months.
- Depigmentation. Removing the remaining color so skin is one even tone. It is permanent and rarely used, usually only when vitiligo covers more than half the body.
Treatment works slowly. Color returns a little at a time, and the face responds best while the lips, fingertips and toes respond least. Because about 40% of people see some color loss within a year of stopping, many plans include maintenance treatment.
Living with it day to day
Sun protection comes first. Skin without color burns easily, and a bad sunburn can make vitiligo worse. Broad-spectrum, water-resistant sunscreen of SPF 30 or higher, reapplied every two hours outdoors, plus shade and clothing. Tanning, in the sun or indoors, makes patches stand out more by increasing the contrast. Some people choose to even out their skin tone with waterproof makeup, a self-tanner or a skin dye. Self-tanners and dyes last about three to five days, makeup about a day. Camouflage is also an option for people who choose not to treat at all. Support groups and talking with a mental health professional help many people with the emotional side.
How to choose a dermatologist
Look for a dermatologist with real experience treating vitiligo. Ask which treatments they offer in the office, especially light therapy. Ask how they will measure progress and what maintenance looks like. Check whether your insurance needs a referral and whether light therapy or newer creams need approval from your plan.
The city list below shows dermatologists who name vitiligo on their own websites.