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Medical Dermatology

Vitiligo

Vitiligo is a medical condition, not just a cosmetic concern. Millions of people suffer from vitiligo and many get it before age 21. About 1% of the world’s population has vitiligo. It is not contagious and is not life-threatening but is disfiguring and negatively impacts self-esteem, and can lead to depression and poor quality of life. Most people have vitiligo for life. It affects people of all different skin colors and affects men and women equally.

What is Vitiligo?

Vitiligo is a condition in which the skin loses its pigment usually on both sides of the body. The affected areas of skin become white or lighter than the surrounding skin. Sometimes the patches progress, grow larger and new patches appear.

Vitiligo can occur on any part of the body, but most commonly appears on the face, neck, and hands. Vitiligo may also affect the mucous membranes (such as the mouth and eyes) and the hair (including the scalp, eyebrows, eyelashes, and beard).

There is no cure for vitiligo, but treatments can help to restore some skin color.

What causes vitiligo?

The cause of vitiligo is not known. Vitiligo causes the cells that give color to the skin, called melanocytes, to die. It may be an autoimmune condition, which means the body’s immune system mistakenly attacks healthy cells. The risk of getting this condition increases when the affected person has a blood relative who has it and when the affected person also has an autoimmune disorder such as thyroid disease or alopecia areata.

What are the types of vitiligo?

There are two types of vitiligo: segmental vitiligo and non-segmental vitiligo. The two types of vitiligo can occur together.

  • Segmental vitiligo is less common and affects only one part of the body. It often starts before the age of 20.
  • Non-segmental vitiligo is more common and can affect any area of the body. It often starts after the age of 20.

Three subtypes tell us the amount of vitiligo on the body:

  1. Local vitiligo: Affects only one or a few areas of the body.
  2. General vitiligo: Affects many areas of the body.
  3. Universal vitiligo: Affects almost the entire body.

How is vitiligo diagnosed?

Your Lucent Dermatology doctor can diagnose vitiligo by its classic appearance. They will carefully review your medical and family history. They will carefully examine the skin and may order blood tests to rule out thyroid conditions and any autoimmune diseases. If you test positive for thyroid disease, treating it will help to control vitiligo. They may examine your eyes since inflammation of the eye, called uveitis, is common in people with vitiligo. Finally, they may take a biopsy of the affected area.

What are the treatments for vitiligo?

There is no cure for vitiligo. The goal of treatment is to slow or stop disease progression, stimulate the growth of new melanocytes, and restore color to affected areas.

Patients may elect no treatment and some treatments can help to restore some skin color. Whether and how to treat is a personal decision to be made with your dermatologist based on your preferences, age, health, and where the affected skin is located. If you choose not to treat, cosmetic options can help camouflage the condition.

The treatments below are typically used for people who have less than 20% of their body affected by vitiligo. Treatment options include:

  • Topical treatments (such as corticosteroids, calcineurin inhibitors, or psoralen plus ultraviolet A therapy) Topical treatments are applied to the skin and can be used to restore pigment or camouflage affected areas. Corticosteroids are often the first line of treatment for vitiligo. About half of patients who choose topical corticosteroids see the return of some skin color with use for 4-6 months, but it usually only works on small areas of the skin. In addition, the use of topical steroids has negative side effects.
  • Light treatments include lasers for small areas and lightboxes for widespread vitiligo. Lasers work best on the face. Many find success but the results may not last. These treatments may be combined with topical treatments.
  • Light therapy with PVUA light is 50-75% effective in restoring color on most areas but not hands and feet, but it is time-consuming.
  • Surgery may be an option when other treatments fail. It may involve skin grafting or transplanting skin cells of healthy skin from one area of the body to the affected area. It is 90-95% effective but there is a risk of scarring and other possible side effects.
  • Depigmentation is the procedure to remove the color from darker skin areas to match the depigmented areas. This treatment is usually reserved for people who have vitiligo on more than half of their bodies. Depigmentation tends to be permanent and can take more than a year to complete. As with other treatments, it is very important to limit exposure to sunlight during and after treatment.

Self-Care

If you have vitiligo, there are several things you can do to care for your skin:

  • Use sunscreen with an SPF of 30 or higher to protect your skin from the sun’s harmful rays. Be sure to apply sunscreen liberally and reapply it often, especially if you are sweating or swimming.
  • Moisturize your skin regularly to help prevent dryness and cracking.
  • Avoid harsh chemicals and abrasive materials that can irritate the skin.
  • Wear loose-fitting, soft fabrics that will not irritate the skin.
  • Avoid tattoos, and tanning beds.

Contact the team at Lucent Dermatology in Beechwood Ohio to schedule a consultation to receive an accurate diagnosis and all your treatment options in the privacy of our state-of-the-art office.


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