White patches on skin: What to know about vitiligo

This dermatology condition causes the skin to lose its pigment and present white patches on skin.

Vitiligo is an autoimmune and genetic condition that affects melanocytes, the pigment (melanin)-producing cells in the skin.  The condition is associated with loss of color in the skin and hair follicles. It causes white patches on the skin and white hair color. This is called depigmentation.

Patients may not notice any loss of skin color until the summer months when they start to tan. This is particularly true for fair-skinned people.

Vanderbilt Dermatology treats people with many skin conditions. Here, dermatologist Aleta Simmons, M.D., explains vitiligo and the type of care it requires.

There are several different types of vitiligo:

• Localized vitiligo is limited to one area of the skin, without spreading for at least two years. Localized mucosal vitiligo affects either the area around the mouth or the genitals. Acrofacial vitiligo involves the head, hands and feet.
• Segmental vitiligo appears in a linear pattern on one side of the body.
• Universal vitiligo is a complete loss of skin color.
• Vitiligo can also happen due to contact with chemicals called phenols. These are typically work-related exposures.

Treatments for vitiligo

There are many treatments, which aim to decrease or stop the destruction of the pigment-producing cells. A dermatologist will make recommendations for treatments depending on the type of vitiligo someone has, and how much of the body surface is affected.

Treatments include potent topical steroids; topical calcineurin inhibitors; oral steroids; phototherapy (therapy using light); surgery; and simply camouflaging the condition with cosmetics. Topical calcineurin inhibitors are used to dial back the immune system activity in the skin without the use of steroids.

There is a topical medication that can be applied to the small areas of remaining pigment to gradually lighten the skin, creating a more even skin tone. Experimental treatments not yet in common use may help with repigmentation. Future vitiligo treatments will likely include hormonal therapy and immunotherapy. Immunotherapy includes medications taken orally to inhibit the immune system.

Protecting against skin cancer

Patients with vitiligo are at risk for developing skin cancers, especially in the depigmented or white areas that have lost their color. Important strategies for preventing skin cancers include using broad spectrum sunscreen every day; wearing wide-brimmed hats; wearing clothing that protects skin from the sun; and avoiding being outdoors in the middle of the day, when the sun is strongest.

People with vitiligo should also be screened for other autoimmune conditions. A doctor specializing in vitiligo does this by discussing medical history, ordering lab tests and asking if the patient has relatives with autoimmune conditions.

There are support groups available for patients with vitiligo such as Vitiligo Support International and Vitiligo Friends – Online Support Group. If you are concerned you or a loved one may have vitiligo, early detection and treatment by a board certified dermatologist is recommended.