Vitiligo

Definition
Vitiligo is a skin condition in which there is loss of pigment from areas of skin resulting in irregular white patches with normal skin texture.

Causes, incidence, and risk factors

Vitiligo appears to be an acquired condition and may appear at any age. There is an increased incidence in some families. Vitiligo is more noticeable in darker skinned people because of the contrast.

The cause of vitiligo is unknown, but autoimmunity may be a factor. This condition affects about 1% of the U.S. population.

Lesions appear as flat depigmented areas with a darker boarder. The edges are sharply defined but irregular. Frequently affected areas are the face, elbows and knees, hands and feet, and genitalia.

Symptoms

     
  • Family history of vitiligo  
  • Sudden or gradual onset of flat normally textured areas of skin with complete pigment loss

Signs and tests
Examination is usually sufficient to confirm the diagnosis. In some cases, a skin biopsy may be needed to rule out other causes of pigment loss.

Treatment

Vitiligo is difficult to treat. Early treatment options include the following:

     
  • Exposure to intense ultraviolet light, such as narrow-band UVB therapy  
  • Oral medications, such as Trisoralen (trimethylpsoralen)  
  • Topical medications       o Repigmenting agents such as Oxsoralen (methoxsalen)       o Immunosuppressants such as Elidel (pimecrolimus) and Protopic (tacrolimus)       o Corticosteroid creams

Skin may be grafted, or removed from normal areas and placed into areas of pigment loss. In the future, skin pigment cells may be grown in the laboratory and used to treat areas of vitiligo.

Support Groups

Expectations (prognosis)
The course of vitiligo varies. Some areas may repigment, but other new areas may appear. Depigmentation may be progressive.

Complications
Depigmented areas are more likely to sunburn or develop certain skin cancers. Vitiligo is associated with three systemic diseases: 1) pernicious anemia, 2) hyperthyroidism, and 3) Addison’s disease.

Calling your health care provider
Call for an appointment with your health care provider if you develop areas of skin that lose their coloring.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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