Vitiligo affects people of all races, including Caucasians. However, the condition is more visible in people with darker skin

Globally, vitiligo occurs in 1% or so of the population. Vitiligo affects people of all races, including Caucasians. However, the condition is more visible in people with darker skin.

Vitiligo can affect people of all age groups, although it is rare in the very young or very old. It often appears between 10-30 years of age.

What is vitiligo?

Vitiligo is a condition in which the skin loses melanocytes, which are pigment-producing cells. This can cause patches of discoloration in the skin, hair, and mucus membranes of the body.

Discolored areas of skin are called macules or patches depending on the size:

• Macules: Under 5 mm
• Patches: 5 mm or larger

6 types of vitiligo

1. Generalized: Most common, where macules appear over various regions of the body
2. Segmental: Limited to one side or one area of the body such as the forearms or face
3. Mucosal: Affects mucus layers of the mouth and sometimes genital regions
4. Focal: Rare, where macules appear in a small region and don't spread in a specific pattern within 1-2 years
5. Trichome: Appears as a an area of skin that is white/colorless in the middle, surrounded by lighter pigmentation, and then normally colored skin
6. Universal: Also rare, where over 80% of the skin of the body lacks color

What causes vitiligo?

Vitiligo occurs when melanocytes are damaged or destroyed and fail to produce melanin—the pigment that gives your skin, hair, and eyes color. While it is unclear as to what makes these color cells fail or die, it may be related to:

• Autoimmune conditions 
• Heredity 
• Triggers such as stress, extreme sunburn, or skin injury

What are the symptoms of vitiligo?

Signs of vitiligo include:

• Patches of skin that are discolored and typically first show up on the hands and face, although they can develop anywhere on the body
• Premature graying of the hair on your scalp or face
• Loss of color in mucus membranes (tissues that line your mouth and nose)

How is vitiligo treated?

Currently, there is no cure for vitiligo. However, various treatments can help depending on your age, how much skin is involved, and how rapidly the disease is advancing.

Medications

• Drugs that control inflammation: Applying corticosteroid cream to the affected skin may bring some color back. This is most effective when in the early stages of the disease.
• Medications for the immune system: Calcineurin inhibitor ointment, such as Protopic (tacrolimus) or Elidel (pimecrolimus), may be effective in individuals with few areas of depigmentation, particularly on the face and neck.

Therapy

• Light therapy: Phototherapy with small-band ultraviolet B can stop or slow the progression of vitiligo. It may be more successful when used with corticosteroids or calcineurin inhibitors.
• Combined psoralen and light therapy: This treatment combines a plant-derived substance called psoralen with light therapy to restore color to the affected patches.
• Depigmentation: A depigmenting agent is applied to the unaffected regions of the skin. This loosens the skin so that it blends with the discolored regions. Side effects may include redness, swelling, tingling, and extremely dry skin.

Surgery

• Skin grafting: Small segments of healthy, pigmented skin are grafted to areas that have lost pigmentation.
• Blister grafting: Blisters are made on your pigmented skin, and then transferred to the affected areas.
• Cell suspension transplant: Tissue is taken from your pigmented skin, cells are placed into a solution transferred onto the affected region. Potential risks of surgery include scarring, infection, and uneven complexion.

Counseling

Vitiligo can cause major psychological issues with body image. Therefore, counseling and support are a vital part of therapy.