What, exactly, is vitiligo? What are the risk factors for it? Are there different types of vitiligo? Find out what causes it and what treatment options are available. We collected some of the most common questions (FAQs) you may have about vitiligo. If you were recently diagnosed with the chronic skin disorder, print these questions and answers to discuss them with your doctor. If you want us to answer a question that’s not there in the list, mention it in the comment section.
1. What is Vitiligo?
Vitiligo is a long-term skin disorder that causes the loss of pigmentation. As a result, white patches (of pale skin color in many cases) appear and grow on the different part of the body. They often first emerge on areas of skin that are exposed to the sun, typically affecting both sides of the body. The progression of the disorder is unpredictable.
About 1% of the world’s population is affected by vitiligo. About 50% of them experience it before the age of 20 while the rest develops it before the age of 40. Unlike Albinism, people with vitiligo are born with pigmentation in their skin. But, as the melanocytes die over time, unpigmented skin appears.
2. Why do white patches appear in vitiligo?
At times, the immune system mistakenly destroys the melanocytes (the cells responsible for pigmentation) in the skin, which results in the emergence of white patches on the different part of the body. However, many researchers firmly believe that in the event of vitiligo, the melanocytes are not destroyed by the immune system; they are destroyed by themselves.
3. What causes vitiligo?
Although research is ongoing, to date there is no known cause of vitiligo. However, it has been closely linked to genetics. People with a family history of the same condition or other autoimmune diseases (such as hyperthyroidism, alopecia areata, and pernicious anemia) often develop vitiligo.
Several studies suggest that vitiligo can be triggered by hormonal changes, recurrent episodes of jaundice or typhoid fever, prolonged antibiotic treatments, and acute emotional trauma. Some even claim that the intake of insecticide/pesticide treated vegetables, usage of heavy immunosuppressant drugs, regular junk food intake and negligence in hygiene can cause the chronic skin disorder. Nothing has been proven so far.
4. What is non-segmental vitiligo?
Nonsegmental vitiligo is characterized by progressive, depigmented lesions of the skin, mucosa, and hair. The total area of affected skin varies between individuals and it is always hard to predict whether the patches will spread, and by how much. The spread might take weeks, or remain stable for months or years. In most cases, the skin affected by nonsegmental vitiligo remains depigmented for the rest of the affected person’s life. Since the condition is photosensitive, affected areas are more sensitive to sunlight. Of all vitiligo cases, about 90% are non-segmental.
5. What is segmental vitiligo?
In segmental vitiligo, the affected area of the skin usually does not expand with time. About 10% of vitiligo cases are segmental. Segmental vitiligo typically appears on one side of an individual’s body. The spots often emerge on areas of skin that are exposed to the sun (commonly hands, face, neck, and legs). These spots range in size from millimeters to centimeters. Since segmental vitiligo has an early onset, it typically is found in young children. The total area of affected skin varies from person to person.
6. What is Universal Vitiligo?
Universal vitiligo is a subset of vitiligo in which more than 80% of the skin color is replaced by white, milky lesions. Characterized by the wide distribution of the patches, it leaves the human body with only a few isolated islands of normal pigmentation (frequently over the malar area of the face and dorsal areas of forearms). In the black community, people with universal vitiligo face a bit of a struggle, having to deal with the racial dynamics of turning white.
7. What is Confetti Vitiligo?
Confetti vitiligo is a term given to describe the confetti-like distribution of vitiligo patches in people affected by the chronic skin disorder. It is an extremely rapidly progressing type of vitiligo that reflects acute damage to mature melanin-forming cells in the skin.
8. Can vitiligo be prevented?
Since the exact cause of vitiligo is not known, it cannot be prevented. However, the appearance of the affected skin can be improved with cosmetics and tattooing (micropigmentation).
9. How is vitiligo diagnosed?
There are no specific diagnostic tests for detecting vitiligo so a skin biopsy confirms the diagnosis. Ideally, a dermatologist who specializes in autoimmunity should carry out the diagnosis. A detailed family history, the individual’s current and past medications history can be taken into account. Commonly recommended tests to determine the exact cause of vitiligo include ANA (Antinuclear Antibody), Thyroid peroxidase antibody (TPOAb), comprehensive metabolic panel, thyroid panel including Free T3, Free T4 and TSH, and lupus panel.
10. Is vitiligo contagious?
Vitiligo is neither infectious nor contagious. Since it is an autoimmune disorder, it cannot be passed through contact or transmitted via touch, saliva, blood transfusion, inhalation, sexual association or the sharing of personal items.
11. Is vitiligo life threatening?
Vitiligo, for being a cosmetic problem, is not a life-threatening problem.
12. Is vitiligo caused by eating certain combinations of foods?
Vitiligo is an auto-immune disorder and has no direct relation to food. In fact, no scientific study has been conducted to confirm that consuming fish and milk together or one after another can cause vitiligo.
13. Does sunburn trigger vitiligo?
Till now, the research has not found any concrete evidence to prove that sunburn causes vitiligo in the first place. However, white spots become noticeable often in an area that was exposed to the sun. Since some experts believe that too much sun can wear out the pigmentation of the skin, it is advised to apply sunscreen to protect patches under the sun.
14. Are all white patches vitiligo?
All the white patches are not vitiligo. There are many other skin conditions (like Chemical Leukoderma, Congenital Leukoderma, Fungal Infections, Leprosy) due to which white spots can appear on the skin.
15. Is vitiligo related to albinism?
Vitiligo is not associated with albinism. In Albinism, an individual is born with no melanin. As a result, one has white skin all over the body since birth. On the other hand, people with vitiligo have normal pigmentation at the time of birth. Once they develop abnormal immune response towards melanocytes, white patches start emerging.
16. Do children of people with vitiligo ultimately develop vitiligo?
Being an autoimmune disorder, vitiligo could have a genetic predisposition. However, of people with vitiligo, only 15-20% have one or more affected first-degree relative. This means 80-85% of vitiligo cases are not liked to family history.
17. Are people with vitiligo eligible for blood donation?
Unless an individual with vitiligo has been declared unfit by a health professional, he/she is eligible for blood donation. Because vitiligo is not transmitted by blood fluids, it does not put the receiver at risk.
18. Can vitiligo be treated with allopathy?
Since the exact cause of the chronic skin disorder is not known, there is no effective treatment to cure vitiligo. The impact of the allopathy treatment for vitiligo may vary from one individual to another. While many people recover completely from white patches during the early stage, some report no sign of improvement. In fact, many people experience temporary improvement and once the treatment is stopped, vitiligo comes back.
Allopathy treats vitiligo with drugs having effects opposite to the symptoms. Side effects of many allopathic medicines are reported in the form of itching, rashes, and skin thinning. Corticosteroid cream, ointments containing tacrolimus or pimecrolimus (calcineurin inhibitors), Prostaglandin E2 and Tofacitinib can be prescribed for vitiligo treatment.
19. Can vitiligo be treated with homeopathy?
Since the exact cause of the chronic skin disorder is not known, there is no effective treatment to cure vitiligo. Many homeopathic drugs are cost-effective and easy to use with less reported side effects compared to conventional medication for vitiligo and phototherapy. While many people recover completely over time, many do not report any sign of improvement and have said that homeopathic treatment made their problem even worse.
The line of treatment attempts to identify the root of the problem to restore the skin color. Commonly prescribed homeopathic medicines include Calcarea Carb, Silicea, Thuja, Sepia, Arsenic Sulph Flavum, Arsenic Album, Arsenicum Sulfuratum Flavum, Causticum 30, Trituration Tablet 6X, Staphysagria 30, Kali Carbonicum, and Borax 30.
20. Can Ayurveda treat vitiligo?
Since the exact cause of the chronic skin disorder is not known, there is no effective treatment to cure vitiligo. Ayurvedic treatment is cost-effective, yet difficult compared to homeopathy and allopathic treatment for vitiligo. While many vitiligo fighters recover completely from vitiligo, some notice no or little sign of improvement. The Ayurveda attempts to stop the melanin destruction and reverse the depigmentation by addressing the root cause.
The one herb most often mentioned with Ayurvedic vitiligo treatment is Vakuchi (Psoralea Corylifolia Linn), which can be taken internally as well as topically. Other herbs prescribed in vitiligo treatment are Majishta Powder, Daruharidra, Aragvadha, Haritaki, Khadira, Bhallataka, Mulaka, Neem, Giloe, and Bedag Lepam.
21. What is Vitiligo Extent Score
The Vitiligo Extent Score (known commonly as VES) is a clinical rating scale for the overall vitiligo involvement of the body (extent). The measurement instrument is made up of evaluation of body surface area (BSA).
The pictures that reflect an individual’s extent of the vitiligo lesions can be selected by this instrument/tool. Based on the pictures, the VES template provides a score that can be expressed in percentage of an individual’s body surface area.
22. Is vitiligo linked to mental health disorders?
It has been observed that vitiligans are at an increased risk for hospitalization for multiple mental health disorders. As per a research published in the Journal of the European Academy of Dermatology and Venereology, vitiligo is associated with an increase in primary hospitalizations for mental health conditions like anxiety, depression, schizophrenia, conduct disorder, adjustment disorders, personality disorder, suicidal risk, ADD/ADHD, childhood and adolescent psychiatric illnesses, alcohol-related disorders, impulse control disorders, developmental disorders, and history of mental health disorders.
The study reveals that out of 87,053,155 hospitalizations in the United States, 11,123 adults had vitiligo. While 4.17% of individuals with vitiligo were admitted to the hospital for a mental health disorder, 27.49% were diagnosed with a mental health disorder at admission.
23. Why is depression common among people with vitiligo?
As per many observational studies, psychiatric morbidity is found more frequent in young individuals with vitiligo and higher in people who have big, white lesions on exposed body areas. However, the variability in study design makes it difficult to quantify the accurate relationship between vitiligo and depression.
If an individual experiences suicidal thoughts, a depressed mood (that lasts longer for at least two weeks), juggling thoughts (about him/her, or the world), and sleep disorders, he/she should be tested for depression in vitiligo. Depression can worsen the vitiligo spread and has the potential to slow down the treatment.
24. How can depression be treated in vitiligo?
One treatment is not viable for everyone as different people with vitiligo experience different symptoms of depression. Many patients may recover through medications while others may need counseling to come out of the depression. At times, a healthy diet and meditation are prescribed alongside medicines and therapy.
25. Are anxiety disorders common among people with vitiligo?
Low self-esteem and deteriorating self-image in vitiligo can contribute to feeling fearful and nervous. If these feelings are extreme and last for more than six weeks, it can be designated as a chronic anxiety disorder (which can radiate in the form of amplified heart rate, irregular breathing, restlessness, trouble concentrating and difficulty remaining or falling asleep). Anxiety disorders can affect anyone at any stage of vitiligo. However, women with vitiligo are more prone to anxiety disorders due to societal pressure and the patriarchal system in some cultures.
26. What causes anxiety in vitiligo?
Anxiety shares complicated causes in vitiligo. It could be due to the emergence of a new white patch (particularly in the facial area), strange stares, unwanted remarks, stressful job, bullying at school due to dual skin appearance, mismanaged emotions, unpredictable course of vitiligo, difficulty in finding love, or rejections in situations due to vitiligo.
Genetics, the side effects of a treatment or stress from another medical condition can be some of the clinical causes. The burden of coping with vitiligo and any combination of the above can contribute to excessive anxiety.
27. How is anxiety treated in vitiligo?
A mental health expert can prescribe the right line of treatment once the anxiety triggers are identified. Based on the diagnosis, Counselling and Antidepressants (or combination of both) can be prescribed. Exercising regularly, dietary changes (including Omega-3 rich foods in the diet), and a daily routine of Yoga poses should also be marinated alongside treatment to quiet aggressive anxiety.
28. What is mixed vitiligo?
Mixed vitiligo is derived from nonsegmental and segmental vitiligo. In some cases, both non-segmental and segmental vitiligo can co-exist in a single individual. This is known as Mixed Vitiligo in common language.
29. Can vitiligo be corrected surgically?
Depending on the spread of vitiligo, surgical methods can be considered. During surgery, good patches of the person’s pigmented skin are removed and grafted to the affected area to cover vitiligo. Some of the widely performed surgeries are Miniature Punch Grafting, Suction Blister Grafting, Split-thickness skin grafting, and Autologous non-Cultured Epidermal Cell Suspensions.
30. How is vitiligo treated with Narrowband UVB phototherapy?
Narrowband UVB phototherapy is a potent melanocytes stimulant and currently being seen as the phototherapy of choice for treating nonsegmental vitiligo. The medical procedure involves exposing vitiligo lesions to fluorescent lamps which emit the ultraviolet light of 310-315 nanometers. The phototherapy stops the progression of vitiligo by suppressing the immune system (which is destroying the pigment-producing melanocytes) in the region to which it is applied.
The degree of repigmentation achieved by the phototherapy depends on vitiligo affected area and the age of the skin disorder. Reported side effects include dryness, itchiness, and redness, which get generally resolved after the application of topical emollients.
31. How does laser treatment work for vitiligo?
Vitiligo can be corrected with any of the 308 nm Excimer Laser, Low-Energy 632.8 nm Helium-Neon Laser, Ablative Fractional Laser, Gain-Switched 311-Nm Ti-sapphire laser and 355-Nm Ultraviolet A1 Laser, depending on diagnosis and prognosis of vitiligo. Due to the optimal wavelength, small vitiligo patches recover faster with laser treatments compared to traditional phototherapies.
308 nm Excimer Laser is the most widely used laser treatment for correcting localized vitiligo. The procedure emits monochromatic light, using smaller, 308 nm wavelengths. The laser’s deep penetration enables the radiation to reach surviving melanocyte in the vitiliginous area. This, in turn, attempts to stimulate melanocyte migration and proliferation from the niche located in hair follicles.
32. What is Depigmentation therapy?
Depigmentation is a method to reduce the skin color of unaffected skin by means of applying strong topical lotions or ointments and laser. If vitiligo has affected 50% (or more) area of an individual body, depigmentation therapy can be considered as an option to achieve even skin tone. It typically takes 2 or 3 months to see any effects while complete transition can take at least 12 months. The treatment leaves the skin without pigment, which in turn, becomes very vulnerable to sun exposure.
Among all bleaching solutions used for depigmentation, only MBEH is FDA approved in the USA. Most prescribed physical therapies for depigmentation include the Q-switched ruby, alexandrite lasers and cryotherapy.
33. What is Leucoderma?
Leucoderma is the de-pigmentation of the skin, which often initiates after a scratch, a cut or after burn. This scar formation results in a gradual development of a white patch. Leucoderma is often, although incorrectly, used interchangeably with vitiligo. Read: 6 difference between vitiligo and leucoderma.
34. What is world vitiligo day?
The World Vitiligo Day (WVD) is observed on June 25, every year, to build global awareness about vitiligo. The purpose of the day is to debunk myths associated with vitiligo. The first World Vitiligo Day was observed in 2011. The choice of June 25 as the World Vitiligo Day was a memorial to Michael Jackson, who suffered from the chronic skin disorder from the early 1980s until his death on June 25, 2009. Know all about World Vitiligo Day here.
35. Is vitiligo mentioned in history?
The first description of vitiligo dates back more than 3500 years in ancient Egypt. It has been mentioned as “Sweta Kushtha” in Indian texts of the Atharva Veda (1400 BC), the Ashtanga Hridaya, the Manu Smriti and the Charaka Samhita (100 CE). It has also been mentioned in Japanese, Greek, Roman, Arabic, and Korean text. However, vitiligo was not very commonly discussed until the 1990′s when Michael Jackson confirmed that he is affected by the chronic skin disorder. Read vitiligo throughout history and cultures.
36. How was vitiligo treated in antiquity?
According to many historical accounts, the ancients used phototherapy as the vitiligo treatment. Both ancient Indian and Egyptian writings confirm that psoralen-containing plants (such as Ammi majus and Psoralea corylifolia) were being applied to pale macules and then exposed to sunlight.
37. Is vitiligo related to other autoimmune diseases?
By using data on 116,320 twins from the Swedish Twin Registry, researchers have found that Addison´s disease and vitiligo often overlap with other disorders. However, more researchers with bigger sample size are required to confirm vitiligo’s connection to other autoimmune diseases.