Vitiligo causes light or white patches to form on the skin. It can affect anyone but is often more noticeable in Black people and those with darker skin tones. 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.
Keep reading to learn more about vitiligo, including its causes, other accompanying complications, and treatment options.
Vitiligo is an acquired skin pigmentation disorder that causes milky-white skin patches. These patches appear due to the loss of melanocytes, the cells responsible for skin pigmentation.
Vitiligo may start in areas more exposed to the sun or more prone to repetitive trauma.
- inside of the mouth
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.
There is currently no cure for the condition, though some people can have periods of remission where skin regains its pigment. However, they can also develop new patches in the future.
What does vitiligo look like on black skin?
Vitiligo affects approximately
Prevalence can vary depending on the country. A
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, 46.7% were white.
However, the condition is more noticeable in people with darker skin tones, such as those of African descent.
Vitiligo is an autoimmune condition. Autoimmunity is where the immune system mistakenly attacks healthy body cells and tissues.
Evidence from 2020 suggests that T cells, which are immune cells, play a role in destroying melanocytes in people with vitiligo.
The risk of a sibling of a person with vitiligo also developing the condition is
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.
Some research shows that the melanocytes in people with vitiligo are inadequate at handling cellular stress. A 2020 review 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.
Evidence indicates that certain drugs may trigger vitiligo. They likely influence the immune system, resulting in the development of the condition. Some medications that may cause vitiligo include:
- imiquimod (Zyclara, Aldara)
- infliximab (Remicade)
- adalimumab (Humira)
- etanercept (Enbrel)
- interleukin (IL)-2, IL-4, and interferon
- pembrolizumab (Keytruda)
- nivolumab (Opdivo)
- vemurafenib (Zelboraf)
- dabrafenib (Tafinlar)
- imatinib (Gleevec)
- gefitinib (Iressa)
While some medications for melanoma, such as pembrolizumab and nivolumab, can induce vitiligo, the depigmentation that occurs is associated with a better outlook.
Doctors can categorize the pattern and type of vitiligo into specific groups. These include:
Nonsegmental 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 often begins in the hands, around the eyes and mouth, the feet, or all of these areas.
This pattern of vitiligo typically follows a start-and-stop cycle. It tends to spread slowly and often 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 include:
- 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 adults with vitiligo.
- Universal: With this rare subtype, depigmentation covers most of the body.
Some clinicians may also include acrofacial and mucosal as nonsegmental vitiligo subtypes. Acrofacial occurs mostly on the face, fingers, or toes, while mucosal mostly appears around the mucous membranes of the genitals 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 type usually presents quickly but then remains stable between 6 months and 2 years.
A medical professional will usually diagnose vitiligo through physical examination. A doctor may use a dermatoscope, a type of hand-held microscope, to examine the white patches. Vitiligo patches typically display a white glow.
They typically use an ultraviolet lamp known as a
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. In some cases, a medical professional may need to take a skin biopsy to diagnose vitiligo.
There is currently no cure for vitiligo. Most treatment options aim to either slow or stop the progression. The most appropriate choice depends on the type of vitiligo and the person’s preference. Some treatment options may include:
Using sunscreen will help protect the skin from skin cancer. People with vitiligo tend to be more vulnerable to skin cancer. 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 slow the progression of vitiligo. A
Other topical treatments may include corticosteroid creams. Doctors may recommend calcipotriol (Calcipotriene) along with a corticosteroid to restore pigmentation.
Other topical treatments, including tacrolimus ointment and pimecrolimus cream, may also help restore pigmentation.
Phototherapy for vitiligo involves using ultraviolet light to stimulate cytokines, such as growth factors in the skin, and promote immune suppression, which prevents the destruction of melanocytes.
Older research notes that healthcare professionals may need to make special considerations for people of color, as they may require
Doctors may suggest oral treatment to slow the progression of vitiligo. These may include:
- oral steroids
- mycophenolate mofetil
Surgery may be an option when phototherapy and medications are not effective. This involves
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, similar to tattooing.
Vitiligo is not contagious. While some people may experience some itchiness when the patches first develop, the condition does not generally have many associated symptoms. However, having vitiligo increases the risk of other complications.
For example, those with vitiligo may be at an increased risk of developing other autoimmune diseases, such as:
- type 1 diabetes
- pernicious anemia
- Addison disease
- systemic lupus erythematosus
- alopecia areata
- lichen sclerosus
In people with vitiligo, 15–25% have at least one other autoimmune disease.
A 2020 study found a higher prevalence of autoimmune disease in the Black participants. The study also found 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
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 in darker skin tones.
Vitiligo can present in different patterns and areas of the body. Treatment options are available, such as creams, medication, phototherapy, and surgery. 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.