Vitiligo

Vitiligo; What It Is and Who’s At Risk

Vitiligo is a skin disorder that causes white patches to appear in place of the skin’s natural color. (1) “Vitiligo is not contagious and is not an infection,” says Michelle Rodrigues, MD, a dermatologist based in Melbourne, Australia. Yet it’s not just a cosmetic issue — it’s truly a medical condition. (2)

People from any race can be diagnosed with vitiligo, but it’s usually most noticeable among people with dark skin because of the contrast between the depigmented skin and the unaffected skin. (1)

Vitiligo affects between 0.2 percent and 1 percent of the population around the world. (3) It doesn’t necessarily affect the skin only. Some people with vitiligo also lose coloring in their mouth, on their eyebrows or eyelashes, or in their hair. (4)

There Are 2 Different Types of Vitiligo and 3 Subtypes

Doctors typically categorize vitiligo as one of the following two types: (4)

  1. Nonsegmental vitiligo (also known as bilateral vitiligo, vitiligo vulgaris, and generalized vitiligo) This is the most common type of vitiligo and results in white patches appearing on both sides of the body. Usually it starts near the hands, around the eyes or mouth, on the feet, or in an area of the body where the skin rubs together frequently. (5) With nonsegmental vitiligo, color loss comes in spurts over the course of one’s life, spreading and becoming more noticeable as time goes on.
  2. Segmental vitiligo (also known as unilateral vitiligo) This type of vitiligo usually starts when a person is young. It generally progresses for a year or so before it stops. Segmental vitiligo appears in one area (or segment, hence the name) of the body, such as on one arm or one leg. In about 50 percent of cases, it’s accompanied by color changes in the hair, eyebrows, or eyelashes. Segmental vitiligo is less common than nonsegmental vitiligo and affects about 1 in 10 vitiligo patients. (5)

Doctors use the following subtypes to describe how much pigment loss appears on the body: (4)

  1. Localized The vitiligo appears in just one or a couple of spots on the body.
  2. Generalized The patches of color loss appear in many areas of the body.
  3. Universal Most of the original skin color is gone. Note: This is very rare.

Unfortunately, there’s no cure for vitiligo, and there’s no way to keep it from progressing. (1) “I always tell patients we will try to bring back any pigmentation that they’ve lost, but there’s nothing we can do to prevent it from spreading because we don’t really understand what causes it,” says Sandy Skotnicki, MD, a Toronto-based dermatologist and the author of Beyond Soap.

Vitiligo Is the Result of Certain Skin Cells Dying Suddenly and Unexpectedly

Melanocytes are cells found in the skin that produce melanin and are responsible for giving the skin its color. (4,6) When these cells die, the skin loses its color — which by definition is vitiligo. Researchers still don’t know for sure what causes these cells to die. (4)

It’s suspected that problems with the nervous system lead to segmental vitiligo, while other types are thought be the result of an autoimmune disease that results in the body destroying its melanocyte cells. (4) In these latter cases (the more common type), Dr. Skotnicki says, “your body is attacking the cells that make pigment.”

For other autoimmune diseases, the mechanisms that cause those conditions to develop are more clearly understood. In the case of vitiligo, there is still no definitive explanation for why the melanocytes die, and therefore many sources stop short of concluding the skin condition is an autoimmune disorder. Still, that is the most widely accepted theory (especially for nonsegmental vitiligo).

So Who Gets Vitiligo? And Is It Always Hereditary?

Vitiligo can technically occur at any age. Usually, though, it occurs in young people, in most cases before one’s 21st birthday. (4) It affects all races and genders equally.

There’s also a strong genetic link: 30 specific gene variations have been found to be associated with vitiligo. (5) But having the genetic makeup for vitiligo doesn’t guarantee you’ll develop it. Usually, something in the environment sets off the condition, such as exposure to ultraviolet rays or chemicals. (5)

Stress on a cellular level can also set off this “attack,” Dr. Rodrigues says. “That stress could be anything from a cut or scratch to a significant illness or stressful life event,” she says.

RELATED: Stressful Events Can Age the Brain by up to 4 Years

The combination of a certain genetic makeup and an environmental trigger is thought to set off an autoimmune response within the body in which the body attacks its melanocytes, resulting in depigmented patches on the skin. (8)

Because there is a genetic component to the disorder, having family members with vitiligo increases the chances that you’ll develop it too. That’s not to say everyone with vitiligo can point to a close relative with it, but about 20 to 30 percent of vitiligo patients can, Rodrigues says. (5) Where the vitiligo occurs on the body and how it progresses, however, doesn’t seem to be passed on from one family member to the next. (9)

For people with vitiligo, triggering events can also cause the condition to spread. For instance, “if someone gets an intense sunburn, they can develop vitiligo in the areas where the sunburn occurred if they already have vitiligo,” Skotnicki says.

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