Vitiligo is a skin condition that causes lighter patches to form on the skin. While it can affect anyone in the general population, it is more noticeable in those with darker skin tones, such as individuals of African heritage. This can lead to other issues such as social stigma.

Vitiligo occurs when melanocytes within the skin and hair die off. Melanocytes are the cells responsible for producing the skin pigment melanin. This pigment gives skin its color and protects against the sun’s UV rays.

The condition is fairly common, affecting between 0.5 to 1% of the worldwide population. It occurs with similar frequency in people of all races but may be more noticeable in individuals with darker skin.

Keep reading to learn more about vitiligo, including its causes, other complications that accompany it, and the treatment options available.

Vitiligo is an acquired skin pigmentation disorder. The characteristic feature of the condition is the formation of milky-white patches in the skin. These patches appear due to the loss of melanocytes, the cells responsible for skin pigmentation.

Vitiligo normally starts in areas that are more exposed to the sun. These include the hands, the face, the feet, the arms, and the legs.

Although it occurs on the skin, vitiligo can also affect any part of the body, including the inside of the mouth, the eyes, nose, and hair.

It can develop in a small patch of skin or occur as multiple patches on the body. It is difficult to predict how vitiligo will manifest in an individual.

The condition can develop at any age and in people of all sexes, but it usually begins before a person reaches 40 years of age.

There is currently no cure for the condition, which does not go away.

Vitiligo affects approximately 1% of the general population. Almost 50% of people with vitiligo present with white patches before the age of 20 years. The age of onset can be earlier if there is a family history of the condition.

Prevalence can vary depending on the country. A 2016 study found that there was a relatively high prevalence of vitiligo in Africa and in women.

However, this does not mean the condition is necessarily more common in people of African heritage. For example, in a 2020 study of 1,487 participants with vitiligo, 46.6% were white.

The condition is more noticeable in people with darker skin tones, such as those of African descent.

Vitiligo appears when melanocyte cells present in the hair and skin die. There are many possible causes for melanocyte cell death, but the exact cause is unknown. Some of the proposed mechanisms of vitiligo include the below.

Autoimmunity

Research indicates that autoimmunity may be the leading cause of vitiligo. Autoimmunity is where the immune system mistakenly attacks healthy body cells and tissues.

Healthcare experts believe that the first line of defense in the body, known as the innate immune system, becomes deregulated and activates immune cells, which destroy melanocytes.

Evidence suggests that T cells, which are immune cells, play a role in destroying melanocytes in people with vitiligo.

Genetic

A person’s risk of developing vitiligo increases if a blood relative also has the skin condition. Research suggests that 20% of people with vitiligo also have a family member with the condition.

The risk of a sibling of a person with vitiligo also developing the condition is 6%. An identical twin of a person with vitiligo has a 23% chance of developing the condition.

Research indicates that genetic variations in more than 30 genes may also play a role in the condition. Two genes that have links with vitiligo are NLRP1 and PTPN22, which have roles in inflammation and the immune system.

Stress response

Some research shows that the melanocytes in people with vitiligo are inadequate in handling cellular stress. Other research notes that melanocytes release reactive oxygen species (ROS) in response to stress. The generation and buildup of ROS can cause further cellular stress and death.

Drug-induced vitiligo

Evidence indicates that certain drugs may cause vitiligo. They likely influence the immune system, resulting in the development of the condition. Some medications that may cause vitiligo include:

  • imiquimod
  • infliximab
  • adalimumab
  • etanercept

Doctors can categorize the pattern and type of vitiligo into specific groups. These include:

Non-segmental or bilateral vitiligo

This is the most common type of vitiligo. It presents on both sides of the body, such as both hands or both legs. It normally begins in the hands, around the eyes and mouth, and/or on the feet.

There is normally a start-and-stop cycle to this pattern of vitiligo. It begins with a quick loss of color, which then stops for a while before starting again. Eventually, the vitiligo becomes more noticeable and covers larger areas of the body.

There are also subtypes of vitiligo, which are:

  • Localized: Where there are very few patches that are only present in a few areas of the body.
  • Generalized: Where patches are present across different areas of the body. This is also the most common subtype in most people with vitiligo.
  • Universal: With this subtype, depigmentation covers most of the body. However, this is rare.

Some clinicians may also include acrofacial and mucosal as non-segmental vitiligo subtypes. Acrofacial occurs mostly on the fingers or toes, while mucosal mostly appears around the mucous membranes and lips.

Segmental or unilateral vitiligo

This is where vitiligo appears on one area of the body, such as on a leg, the face, or an arm. This normally begins at a young age and continues for a year before stopping.

A medical professional will normally diagnose vitiligo through examination. A doctor may use a dermascope, a type of microscope, to examine the white patches. Vitiligo patches normally display a white glow.

They may also use an ultraviolet lamp known as a Wood’s lamp to help detect the condition.

Doctors may also ask questions regarding when the patches first appeared and how long they have been present. They may also request a person to take regular photos of the patches to track the progression of the vitiligo.

Additionally, a healthcare professional may arrange for some blood tests to check if other autoimmune diseases are also present.

There is currently no cure for vitiligo — most treatment options aim to either slow the progression or stop the condition. The most appropriate choice will depend on the type of vitiligo and the person’s preference. Some treatment options may include:

Topical treatment

Using sunscreen will help protect the skin. Some people with vitiligo may also use cosmetics, such as makeup and skin dyes, to cover up the white patches.

Certain medicated creams may also help in slowing the progression of vitiligo. A 2020 study found a link between the usage of ruxolitinib cream and repigmentation of vitiligo patches when a person applied it consistently for a number of weeks.

Other topical treatments may include corticosteroid creams.

Phototherapy

Phototherapy for vitiligo involves using ultraviolet light to stimulate growth in the skin and prevent the destruction of melanocytes via immune suppression.

A 2017 study found that phototherapy was not effective on vitiligo in the hands and feet but showed positive effects in the face and neck.

Older research notes that healthcare professionals may need to make special considerations for people of color, as they may require different dosing of light therapy.

Oral medication

Doctors may suggest oral treatment to slow the progression of vitiligo. These may include:

  • oral steroids
  • methotrexate
  • ciclosporin
  • mycophenolate mofetil

Surgery

Surgery may be an option when phototherapy and medication are not effective. This involves removing the depigmented area of skin and replacing this with pigmented skin from another area of the body.

This treatment option can be effective in 90–95% of people.

Other treatment options

Other treatment options for vitiligo may include depigmentation, where doctors remove the remaining natural pigment from the skin. Another technique is micropigmentation, which involves implanting natural pigment particles under the skin.

Vitiligo is not contagious. While some people may experience some itchiness while the patches first form, the condition does not generally have many associated symptoms. However, vitiligo increases the risk of other complications.

For example, those with vitiligo may be at an increased risk of developing autoimmune diseases, such as:

Between 15–25% of people with vitiligo have at least one other autoimmune disease.

A 2020 study found that there was a higher prevalence of autoimmune disease in the Black participants. The study also found that there was a higher prevalence of hypothyroidism in people with vitiligo.

A 2021 study also found an association between vitiligo and a type of hearing loss known as sensorineural hearing loss.

In people with darker skin, vitiligo may be more distressing as it is more noticeable. They may experience stress, as well as other psychological effects such as:

For example, a 2017 study looking at vitiligo on black skin found that people with darker skin experienced more social stigma. This was also due to people confusing vitiligo with leprosy.

Vitiligo is a skin disorder that results in the loss of natural pigment in the skin. While it affects people from all races equally, it can be more distressing in individuals with darker skin. This is because the white patches that characterize the condition are more noticeable.

Vitiligo can present in different patterns and areas of the body. Treatment options, such as creams, medication, and surgery, are available. These will depend on the type of vitiligo the individual has and the progression of the condition.

Doctors should give special consideration to Black people with vitiligo due to the higher likelihood of social stigmatization and other psychological effects.