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Patient Information Leaflet

Vitiligo

What are the aims of this leaflet?

This leaflet has been written to help you understand more about vitiligo. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it.

What is vitiligo?

Vitiligo is a condition in which areas of skin lose their normal pigment and so become white. It is common, and affects about 1% of the world’s population.

What causes vitiligo?

The pigment that gives your skin its normal colour is melanin, which is made by cells known as melanocytes. The cause of vitiligo is not yet fully known but many think that it is a disease in which the body makes antibodies to its own melanocytes, and in doing so destroys them. After that, the skin cannot make melanin properly, and vitiligo is the result. In support of this idea is the way that people with vitiligo are more likely than others to have diseases, caused in much the same way, of other organs such as the thyroid.

It affects men and women of all races equally, but is most easy to see in people with dark skins. It is not catching.

Is vitiligo hereditary?

Only about a fifth of people with vitiligo know of someone in their family who has it; but the exact type of inheritance has not yet been worked out. One problem here is that so many people have no idea if their relatives are hiding vitiligo under their clothing.

If you have vitiligo, it does not follow that your children are sure to get it too.

Diet. There is no medical evidence of any dietary link and vitiligo. Therefore no dietary changes are recommended.

What are the symptoms of vitiligo?

These fall into two groups:

1. The sun burns the pale areas very easily. This is sore, and when the burn has settled down, the pale areas of vitiligo will stand out, more strikingly than before, against a background of tanned skin.
   
2. Many people become embarrassed or depressed by the look of their vitiligo, and by the questions that other people ask them about it.
   

What does vitiligo look like?

The most common sites for vitiligo are:

• The exposed areas – vitiligo often begins on the hands and face.
  
• Around body openings: the eyes, nostrils, mouth, umbilicus, and genitals.
  
• In body folds: the armpits and groin.
  
• Anywhere your skin has been damaged, for example by a cut or a burn.
  
• Areas around pigmented moles (as part of “halo naevi”).
  
• In one rare (segmental) type, vitiligo crops up on just one part of the body.
  

Although vitiligo not more common in people with a dark skin is it much more obvious. Premature greying of the scalp hair can accompany vitiligo.

Course of the disease. Vitiligo can start at any age, but about half of those who get it do so before they are 20. Its course is hard to predict, but it tends to progress slowly, with periods of stability, often lasting several years. The patches slowly change their shape and size, and the skin around them may be darker than normal. The hairs growing out of a patch of vitiligo may keep their normal colour or turn white too.

Some pigment comes back in a few patients but seldom does so completely. If it returns via the hair follicles, the areas do not look much better when they turn from white to speckled.

How will vitiligo be diagnosed?

The diagnosis is usually easy to make on the basis of the look of the patches (white with a normal skin texture) and the fact that the areas of vitiligo on the left side of the body roughly mirror those on the right. An ultraviolet light  (Wood's lamp) can help to show up white areas that could have been missed in a pale-skinned person.

Once the diagnosis of vitiligo has been made, your doctor may want to check you for thyroid disease, and for other autoimmune conditions that are more common than usual in people with vitiligo.

Can vitiligo be cured?

Vitiligo occasionally goes away by itself, and some treatments may slow its progress, but a cure cannot be guaranteed.

How can vitiligo be treated?

The treatment of vitiligo does not always work, and you should discuss the options in detail with your GP or dermatologist. Often no treatment is needed other than good cosmetic cover especially in pale skinned individuals.

1. Using a strong corticosteroid cream. This gets some pigment back in new and early patches - but side effects, such as thinning of the skin, are a real risk with continued use.
2. Sunscreens. The pale areas (vitiligo) on your skin will burn easily in the sun. The use of a sunscreen with a sun protection factor of 25 or higher helps to prevent burning. In light-skinned individuals, it also minimises pigmentation of the skin around the patches of vitiligo.
3. Other creams. Calcineurin inhibitors and vitamin D analogue creams can also work in some patients to bring pigment back.
4. Phototherapy (see Phototherapy PIL).
   a.    Narrow band ultraviolet light of type B is the preferred treatment for widespread vitiligo.
   b.    PUVA treatment. In this, you will be given a Psoralen tablet to take by mouth, and then be exposed to Ultra Violet light of type A - hence the word PUVA.
   With both these treatments you will have to attend a skin department regularly and frequently (twice a week) as decided by your doctor. Even then the chance of getting a reasonable amount of pigment back may only be about 50%. Localised small patches of vitiligo may be treated with a psoralen gel, paint, or cream, in combination with ultraviolet light of type A.
   
5. Surgical procedures. These are best reserved for stable lesions in cosmetically sensitive areas. They are still being developed and are not yet in general use.
   
6. Removing the remaining pigment. If the vitiligo has spread very widely (more than 50% of body) or a large area of the face it may be easier to get rid of the small amounts of pigment that are left using a bleaching chemical (a hydroquinone) than to get the lost pigment back. The even white colour gained in this way may be less ugly that a mixture of dark and pale areas, but the social implications of becoming white all over must be discussed before this treatment is used.
   
7. Psychological treatments. This may be offered as a way of coping mechanisms in select cases of vitiligo.
   

What can I do?

• The pale areas on your skin will burn easily in the sun and tanning will make the contrast between the white and normal skin more obvious. Be careful in the sun; use sunscreens and protective clothing.
  
• Learn about the how to hide the white areas with cosmetics. Cosmetic camouflage teams can provide expert training for patient in the use of cosmetics. There are now good quality camouflage cosmetics in a range of colours that are hard to rub off, and can be waterproof. Keep your self-confidence high by making your skin look as normal as possible.
  
• Don’t waste time changing your diet - this never does much good.
  

Where can I get more information about vitiligo?

Links to patient support groups:

The Vitiligo Society, 125 Kennington Road, London SE11 6FS
www.vitiligosociety.org.uk

Other Websites:

www.vitiligosupport.com and www.nvfi.org

Web link to a detailed leaflet:

www.aad.org/pamphlets/Vitiligo.html

The British Skin Foundation fund vital research into all skin diseases.  To find out how you can help, please visit the British Skin Foundation website here

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: its contents, however, may occasionally differ from the advice given to you by your doctor.

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED AUGUST 2004
UPDATED MAY 2010