Vitiligo: Types, Causes, Symptoms, Diagnosis and Treatment Options

Author
Leading Cosmetic dermatologist
Indian Board Certified Cosmetic Dermatologist
M.D, DVD, DNB
IADVL MEMBER

Introductionwhat is vitiligo, Vitiligo, Hands explained

  • Are you feeling low due to random white patches on your skin?
  • Are you facing problems in social as well as personal life due to those weird white patches?
  • Is living with vitiligo stealing your self confidence?
  • Do you constantly need to hide your vitiligo when going outside?

If the above concerns are true then don’t worry as here our expert board certified dermatologist Dr Shweta explains everything you need to know about vitiligo and also offers some treatment options so that you can live your life happily again.

The causes due to which vitiligo occurs are as follows

  • Immune system problems: Sometimes due to existing auto-immune disorders such as thyroditis,lupus,psoriasis,type 1 diabetes, alopecia aerata, Addison’s disease, rheumatoid arthritis or scleroderma the immune cells mistake the melanin producing cells called as’melanocytes’ as foreign body.
  • This causes the melanocyte cells to be attacked by the immune system cells which cause their destruction and thus the pigment that gives color to your skin is lost leading to development of those white patches.
  • Genetic factors: Any kind of damage to your DNA can trigger vitiligo either due to mutation or external factors as it is found that over 30 genes are the main culprits which can elevate your chances for development of vitiligo.
  • Having vitiligo in your family makes you more vulnerable to develop it too.
  • High stress: The quantity of melanin your melanocytes make can undergo change if you constantly undergo physical or emotional stress specifically after an injury.
  • Environmental factors: Some toxins and chemicals or even ultra violet light arriving from the cells can damage your melanocytes thus causing vitiligo.

Vitiligo can appear on any area of your body such as

  • Areas commonly exposed to the sun such as arms, feets, legs and face
  • Nostrils
  • Within the mouth or other mucous membrane
  • Back or inside of your ears
  • Genital areas
  • Back side

 

However your dermatologist can also use an instrument having Ultra-violet light called as Wood’s lamp to confirm if you have vitiligo and not other similar skin conditions such as albinism,psoriasis,tinea versicolor ,pytiriasis alba,nevus depigmentosus,nevus anemicus,tuberus sclerosis,waardenburg syndrome,oculo cutaneous albinism, lichen striatus,leprosy,post-klaazar dermal leschminiasis,pinta,polymorphous light eruption, contact depigmentation,lichen sclerosus et atrophicus, down’s syndrome, celiac disease and topical steroid abuse which forms the differential diagnosis


Normally visual examination is done to detect if you have vitiligo

The symptoms of vitiligo can start to affect a small area or can affect very large areas.

Sometimes people experience itching before the skin starts to lose color.

The hallmark signs are

  • There is appearance of patches on the skin or mucous membrane which are either white or lighter in tone than your natural skin color.
  • The patches can also affect hair on your body turning them silvery ,grey or pure white

Vitiligo is a rare phenomenon and is seen in about 1 to 2% of the population.

  • However it is more prevalent in children (seen in 50%) out of which 25% cases occur before than age of 10 and the rest 25% before the age of 20%.
  • In Southern India vitiligo is seen in 26% of children while the figure is 23.3% in Northern India.


Vitiligo is classified according to the pattern in which it appears on your body or its appearance and the areas it affects for example

  • Generalized: This form of vitiligo affects many parts of your body where white patches appear and is the most frequently encountered. It commonly starts and stops over the course of a person’s lifetime.
  • Universal: When more than 80% of the pigment is lost all over the body then this type of vitiligo is called as universal vitiligo.
  • Segmental: This is also knows by unilateral vitiligo i.e. one sided where one side of the body undergoes rapid pigment loss and it continues for about 6 to 12 months and then stops.
  • Non-segmental: In this type the depigmentation takes place on both the knees and legs, hands etc.
  • Mucosal: In this type white patches appear in mucosal areas such as inside the mouth or other areas
  • Focal: This is an uncommon type of vitiligo where white macules don’t spread in a fixed pattern over a period of years and also remain localized to a specific area.
  • Trichome: In this type a bull’s-eye type of formation occurs where a central white or colorless patch is surrounded by a space of lighter skin tone after which there is your natural skin color.

A variety of methods are used for vitiligo treatment which include

 

1] Non-surgical options

PhototherapyUV light chamber

  • Psolaren and ultraviolet light therapy A (PUVA): This approach of treatment makes use of a specific medicine called as psolarens which are administered either as in form of a pill or topically in form of cream.
  • This medicine is then ‘activated’ by means of ultra-violet A light by a machine.
  • This machine is in form of a whole body chamber where lights are attached to their sides which are shone on the body and protective glasses are provided for the eyes.
  • Side effects of this treatment include nausea, itching, sunburn and hyper pigmentation.
  • Narrowband ultraviolet B therapy:

  • This treatment is used as a substitute to PUVA and here a more focused beam of ultra-violet B is passed and has upper hand over PUVA of having lesser side effects.
  • This treatment can also be done at home under supervision of your dermatologist by means of a hand held device.
  • In case of whole body the whole body chamber is used as mentioned before having UV-B lights attached to its side.
  • In case of localized areas such as hand and foot a machine where provisions for keeping your hand and feet are made.
  • Excimer laser therapy: This therapy is uses UVB light at 308nm which is targeted at specific areas where depigmentation has taken place in order to restore original skin color.Excimer laser machine
  • Advantages over traditional PUVA include no damage to surrounding skin as only the specific area is exposed to the light, targeting areas which are not easy to access such as behind your ears or on genitals, can be used on children.
  • Self tanners camouflage and skin dyes: These products can be used along with your existing treatment by recommendation with your dermatologist.
  • They make your skin tone instantly and last anywhere from 3 to maximum of 5 days.
  • They are also unaffected by water but require practice to apply it properly.
  • Medications
  • Immunomodulators: These types of medicines halt or slow down your immune system from attacking your melanin cells.
  • Examples include topical medicines such as calcineurin inhibitors such as tacrolimus or pimecrolimus which can be effective in localized areas such as your face or neck.
  • However some drawbacks are found to be associated with the use of these medicines such as skin cancer and lymphoma.
  • Corticosteroids: These are only available by prescription in either oral such as pill or in form of cream by your dermatologist.
  • One such orally used steroid is betamethasone which has significantly less side effect than other steroid which is weight gain with absence of cushingoid features.
  • Newer steroids are available in topical form which have lesser side effects are mometasone furoate and fluticasone.
  • Common side effects of steroids may include but not limited to decrease in skin thickness, irritation of skin, unwanted hair growth and others when used for extended period of time.
  • Monobenzone: This medicine is used in a specific therapy called as ‘depigmentation therapy’.
  • This therapy is used when you have lost about 50% or more of your original skin color and the treatments that are used to restore your pigment have failed.
  • Now the goal is to make your skin to match closely to the tone which has faded so that you get an even skin tone all across your body.
  • This is available in the form of cream but treatment normally takes about 2 years and is not reversible and it also carries some side effects such as enhanced sensitivity towards sunlight and more inflammation.
  • Janus Kinase inhibitors: These medicines such as Ruxolitinib are available in form of cream and are prescribed in non-segmental vitiligo in patients who are older than 12 years.
  • Vitamin D Derivatives: These medicines are normally used as a second line treatment and only in combination with other medicines as oral therapy. Examples are calcipotriol and tacalcitol
  • Decapeptide therapy: This medicine is a cocktail of proteins which induce repigmentation in depigmented areas by migration of the melanocytes to the affected areas.
  • It is available in the form of topical lotion which is to be applied in the night and kept undisturbed followed by exposure to sunlight in the morning to start the repigmentation process.
  • Bavchi oil: It is naturally available oil that revitalizes the skin and removes all toxins thereby also clearing white patches and thus is useful in vitiligo.

2] Surgical options

In case the phototherapy methods have failed to show results then surgical options are available. These include

  • Skin Grafting: In this approach your dermatologist will transfer some parts of your healthy pigmented skin to the unpigmented areas.
  • This procedure is preferably used if small sections are to be treated.
  • Possible side effects are infection, scarring, cobblestone skin, spotty color etc.
  • Blister Grafting: Here your dermatologist makes blisters on top your skin and then transfers the top part of the blister skin to the depigmented areas with the help of suction.
  • Possible side effects are infection, scarring, cobblestone skin etc.
  • Cellular suspension transplant: In this approach some tissue of your pigmented area is taken and immersed in a liquid media.
  • The media is enriched by certain enzymes which separate epidermis from dermis followed by which the melanocyte cells are released which are then transferred into a liquid medium which may consist of patient’s own serum and other growth factors.
  • These pure melanocyte cells having more tendencies to divide are then transplanted onto the depigmented areas.
  • Repigmentation normally starts within a span of 4 weeks.
  • Side effects are scarring, infection and uneven skin tone.


The cost of vitiligo treatment depends on the type of treatment that is required and also on the number of lesions that are present. Your dermatologist is the best to guide you on the cost.

Before proceeding, consult your dermatologist if you have any concerns or questions. Your dermatologist can assist you in determining the cause of your skin problem and can help also is assessing which type of vitiligo treatment is right for you. Your dermatologist can then develop a treatment plan that is right for you. That one visit could make a significant difference in your quality of life for years to come. If you and your dermatologist agree that procedure is the best choice for you; your dermatologist will devise a tailor made treatment plan exclusively for you. If you have taken any kind of previous skin related treatment, be sure to tell your dermatologist about that before the treatment begins.

  • In order to minimize the side effects of cosmetic treatments it is necessary that you choose a Board Certified Cosmetic Dermatologist.
  • Shweta is one of the most renowned names in cosmetic treatment in Mumbai serving thousands & thousands of patients happily, including Bollywood Celebrities and many patients from out of the country.

We at Allure Medspa in India, have world-class facilities in place to cater to your every need when it comes to cosmetic surgery or treatment. Here we have dedicated to the best results and the best medical centre for skincare treatment as well as cosmetic surgery in India.

CAN VITILIGO GO AWAY?

Vitiligo cannot be cured, but it can be managed well by taking appropriate treatments by consulting a board certified dermatologist.

IS SUNLIGHT GOOD FOR VITILIGO?

It was seen that when patients took folic acid and vitamin B12 in conjunction with subsequent receiving of sunlight then in 64% of cases the spread of white patches stopped completely.Repigmentation was also seen after this treatment.

WHAT HAPPENS IF VITILIGO IS LEFT UNTREATED?

Though it cannot cause any serious issues but other skin areas can get involved and the patches may spread in extensive areas of the body.

This can cause anxiety and social withdrawal due to the way the person looks.

WHICH FOODS ARE GOOD FOR VITILIGO?

Backed by research these foods were found to be helpful in this condition. These are bananas, apples, figs and dates, chickpeas, leafy greens, beets, carrots and radishes.

WHAT SHOULD PATIENTS AVOID IN VITILIGO?

Follow these tips if you don’t want your vitiligo to get worse.

  • Ditch tanning beds/sun lamps.
  • Keep away from cuts, scratches and burns.
  • Always use sunscreen when going outside
  • Think before getting a tattoo
  • Support your immune system so that attacks can be reduced by means of yoga and other stress reducing methods.

SHOULD I GET VACCINATED IF I HAVE VITILIGO?

It is safe to get vaccinated as only a part of your immune system attacks and not the whole system.Getting a vaccine would not make your vitiligo worse.

4.9

161 reviews