Vitiligo: Your GoodRx Guide

Definition

Vitiligo is a condition that causes patches of skin to lose their natural color and turn white. Vitiligo affects up to 2% of people, and it can occur anywhere you have skin, including your genitals and mouth. Your hair can be affected, too. Some people will have only one or two small patches; for others, almost all their skin will be involved. 

Vitiligo is not life-threatening, but it can significantly impact your life. The condition can cause symptoms like low self-esteem and depression. Fortunately, there are different treatments for vitiligo that work well.

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Causes

Scientists don’t know exactly what causes vitiligo, but most studies indicate that it’s an autoimmune disease. Specialized skin cells called melanocytes make melanin, the pigment that colors your skin and hair. In vitiligo, cells in your immune system attack your melanocytes, so they can’t make melanin anymore. This makes the skin lose its natural color and appear white, and it can happen in people of all skin colors and races.

Vitiligo can affect people of all ages, but almost half the people who have it got it before age 20. Children are most likely to get it between ages 5 and 10. Vitiligo affects all genders, but women usually get it at a younger age than men do.

Like many other autoimmune disorders, your genes and your environment can increase your risk: 

• If you have a first-degree relative that has vitiligo, you have about a 6% chance of getting it. But your risk isn’t all about your genes. Studies have found that, in identical-twin pairs, if one twin has vitiligo, the other has only about a 20% chance of having it. 

• Some products, like certain paints, adhesives, and insecticides, that contain the chemical phenol can trigger vitiligo. 

• For some people, vitiligo first starts after some type of stressor — like pregnancy or severe psychological stress. For others, there isn’t a clear starting point or cause. 

Having another autoimmune condition — especially thyroid disease (like Hashimoto’s disease) or hair loss (alopecia areata) — can also increase your risk of getting vitiligo.Getting a diagnosis 

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Symptoms

Vitiligo mainly affects the skin, but it can cause other health problems, too. 

Skin changes

The characteristic patches of white skin can affect skin anywhere on the body. The size and number of patches varies from person to person, but most people don’t feel any symptoms when their skin loses its color.  

There are some common patterns of vitiligo, but unfortunately it’s not possible to predict how different people will be affected:

• Generalized: The most common pattern of vitiligo. Many patches appear all over the body. Patches typically start on the hands or feet or around the eyes or mouth. 

• Localized: Vitiligo is restricted to one or two patches that don’t really change. 

• Universal: A rare type that affects most of a person’s skin.

Other health problems

People with vitiligo can also experience problems with: 

• Hearing loss (affects between 10% and 40% of people with vitiligo) 

• Eye problems such as night blindness, redness, pain, or sensitivity to light (affects up to 40% of people with vitiligo) 

• Sunburn 

• Low self-esteem

• Anxiety

• Depression

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Diagnosis

Your provider can usually diagnose vitiligo by examining your skin. They may use a handheld device called a Wood’s lamp, which uses black light to highlight areas of skin that have lost color.

There are other conditions that can resemble vitiligo, so sometimes a skin biopsy is needed. A skin biopsy is a small surgical procedure done in your provider’s office. Your skin will be numbed with a needle, and a small piece of tissue (about the size of a pencil eraser) will be removed. You may get a stitch put in afterward to help the area heal. The specimen is sent to a lab, where specially trained physicians will evaluate it under the microscope.

Because it’s common for people who have vitiligo to have other autoimmune conditions, your provider may ask whether you or anyone in your family has an autoimmune condition, like: 

• Thyroid disease

• Alopecia areata

• Inflammatory bowel disease

• Pernicious anemia

• Lupus erythematosus

• Rheumatoid arthritis

They may also recommend a hearing test because hearing loss can be easy to miss in its early stages. 

Medicated creams

There is no cure for vitiligo, but there are good treatment options that can stop it from getting worse and that can even help your skin regain its natural color. Sometimes, two or more treatments are combined for better results. 

So far, Opzelura is the only FDA-approved treatment for vitiligo that re-pigments skin. The other treatments are used off-label. We’ll go over common treatment options first, then we’ll review how your provider may decide which treatments to recommend.

Corticosteroid creams are usually the first-choice treatment for vitiligo. Opzelura is also a good first choice, especially for treating sensitive areas like the face. You can try (or add) other creams if you don’t have a good response to the initial treatment.

• Corticosteroids: These are usually used topically as creams or gels, but they can be taken as pills (such as prednisone) in some situations. Examples of topical corticosteroids include fluticasone (Cutivate) and clobetasol (Temovate).

• Topical calcineurin inhibitors: These have fewer side effects than do steroids, so they are used on sensitive areas, like the face or genitals. Some examples include tacrolimus (Protopic) and pimecrolimus (Elidel).

• Janus kinase (JAK) inhibitors: These are a new class of medications that work by blocking signals in the immune system that cause inflammation. Opzelura (ruxolitinib) is the first cream in this class approved to treat vitiligo. People 12 years of age and older can use Opzelura twice a day (including on their face). Researchers are studying other JAK inhibitors as possible treatments for vitiligo. 

• Vitamin D creams and ointments: Medicated creams that contain a form of vitamin D, like calcipotriene (Dovonex), also lower the immune response and can treat vitiligo. They work best when you combine them with other treatments, like topical steroids.  

Without treatment, vitiligo can spread to involve larger areas of skin. Waiting a long time to treat your vitiligo — like 1 to 2 years — can make it harder to treat, so it’s important to try to get treatment as soon as you can.

If the vitiligo is spreading quickly, your provider may have you take a course of oral corticosteroids to keep it from progressing

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Treatments

When creams alone don’t work, the next step is usually to add light therapy. There are other treatment options too. 

Remember, each person is unique and has a different treatment plan. Deciding which treatment to get depends on many things, including where vitiligo is affecting you, how much skin is involved, and how much the vitiligo bothers you. 

Light therapy (phototherapy)

Light therapy involves short courses of specific wavelengths of light that treat larger areas of affected skin. Some examples of light therapy are:

• Narrowband ultraviolet B (NBUVB)

• Psoralen and ultraviolet A (PUVA), a medication taken by mouth that makes the skin more sensitive to ultraviolet light and helps the UVA work better

• Excimer laser, a small handheld laser than can be used for small areas

Light therapy is a treatment you get at your provider’s office, in a machine that looks like a tanning bed that you stand in. It’s different from regular tanning beds, which shouldn’t be used because they’re more likely to cause skin cancer.

Sunscreen

Sunburn can make vitiligo worse — so if you have it, use sunscreen every day. The best sunscreen is broad spectrum (protects against UVA and UVB rays) and is SPF 30 or higher. We still don’t know whether vitiligo can increase your risk of getting skin cancer, but it’s good practice to wear sunscreen daily. 

Other treatments

Surgery can be used to treat vitiligo that hasn’t changed for at least 6 months. There are different procedures, but most treatments involve removing small pieces of skin with your natural color and putting it where the affected patches are. Surgery doesn’t always work, and there is the risk of infection or developing a cobblestone-like appearance on the skin.

Depigmentation treatments that gradually lighten (depigment) the natural skin so that it blends better with the vitiligo can be an option for people with extensive vitiligo that hasn’t responded to other treatments. This is a permanent change, and it can be done with prescription creams or certain lasers.

Some people choose to conceal or camouflage the patches of vitiligo with makeup, self-tanner, or permanent tattoos.

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Living

Vitiligo can be very visible, and people who have it might find themselves dealing with poor self-esteem, depression, and anxiety. This is especially common in children. Psychological support — like a referral to a mental health specialist — is an important part of treatment when it’s needed.

If you have vitiligo, connecting with others who also have it may be helpful. Online support groups like Vitiligo Friends and Vitiligo Support Group are good places to start.

Other sources of information include:

• The American Academy of Dermatology Association

• The National Institutes of Health