Vitiligo on Fair Skin: How to Tell If You Have This Common Condition (With Pictures)

Vitiligo is a chronic condition that causes white patches on the skin. In people with darker skin tones, vitiligo is usually pretty easy to spot. But it can be more subtle in people with lighter or fair skin tones. To make it even more challenging, there are other common conditions that cause white spots and can be mistaken for vitiligo. 

Here, we’ll review what you need to know about vitiligo on white skin, including what it looks like, other conditions that can mimic it, and the best way to treat it. 

What is vitiligo?

Vitiligo causes patches of skin to lose their color and eventually turn white. Scientists aren’t exactly sure what causes vitiligo. 

Some experts think vitiligo may be caused by an autoimmune condition that affects melanocytes. Melanocytes are special skin cells that make melanin, the pigment that gives your skin and hair their color. In vitiligo, your immune system attacks melanocytes so they can’t produce melanin. This causes skin and hair to lose their natural color and turn white. 

Symptoms of vitiligo 

When you have vitiligo, white patches can appear anywhere on your skin. And there aren’t usually any other symptoms. The number and size of patches and how much total skin is affected varies from person to person. 

Here are some common patterns of vitiligo:

• Generalized: This is the most common type. Multiple patches can appear on the face and body, usually in a symmetric pattern (affecting the same area on both sides of the body). 

• Localized: A few patches develop in one or a few places on the body. 

• Universal: This is an uncommon type that involves most of the skin. 

• Segmental: This is the least common type that affects only one side of the body. 

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• The best vitiligo treatments: From creams, pills, and light therapy, find out which vitiligo treatments work best. 

• Living with vitiligo: Read how one woman went from hiding to helping others with vitiligo. 

• Is there a cure for vitiligo? No. But, these treatments can restore lost skin color and keep new patches from forming.

What does vitiligo look like in people with fair skin?

Vitiligo causes milky-white patches that are different sizes and shapes. As the patches grow, they can sometimes appear pinkish-white. 

Vitiligo is hard to see in people with fair skin because there isn’t as much contrast with the surrounding skin. Vitiligo skin doesn’t tan (in fact, it burns easily). So, it may be easiest to see in the summer as healthy surrounding skin tans. Here are some pictures of vitiligo on white skin. 

Early vitiligo starting on the finger.

Vitiligo on fair skin can be hard to see.

Vitiligo on the face can cause eyelashes to turn white.

White and pink vitiligo patch on fair skin.

What can be mistaken for vitiligo?

Other skin conditions can cause white patches on the skin and be mistaken for vitiligo. You may have to see a dermatologist to know which one you have. They can often make the diagnosis by examining your skin and using a special handheld light called a Wood’s lamp. Sometimes, a skin biopsy is needed to make the diagnosis. 

Here are some common conditions that look like vitiligo. 

Pityriasis alba

Pityriasis alba causes lighter patches of skin, usually on the face, chest, or arms in children and teenagers. It’s more common in people with eczema. Unlike vitiligo, the patches of pityriasis alba still contain some color pigment and don’t have sharp borders. 

Idiopathic guttate hypomelanosis

Idiopathic guttate hypomelanosis (IGH) causes multiple small, round, white spots, usually on the arms and legs. The cause of IGH isn’t known. But it may run in families and be related to sun exposure. 

Tinea versicolor

Tinea versicolor is a fungal infection that causes light-colored patches, usually on the face, upper back, chest, and upper arms. Unlike vitiligo, it can be itchy, and it’s usually scaly — not smooth.

Post-inflammatory hypopigmentation

Post-inflammatory hypopigmentation is white spots that develop after skin inflammation heals. This can happen after a skin injury (like a scrape) or a rash (like acne) heals. We’re not sure why it happens. But the inflammation seems to change the level of melanin pigment in the skin. 

How do you treat vitiligo on fair skin?

The treatment options for vitiligo are the same for all skin tones. There’s no cure, but treatments can help stop vitiligo from spreading and help your skin regain its natural color. Deciding which treatment is right for you depends on many things, including how much the vitiligo bothers you, how much skin is involved, and where you have it. 

It’s common to combine treatments and change treatments if they don’t work well. Here are the main treatment options for vitiligo: 

• Medicated creams: First-choice treatments usually include Opzelura (an FDA-approved JAK inhibitor) and corticosteroids (like betamethasone). Other options include calcineurin inhibitors, like tacrolimus (Protopic), and vitamin D creams, like calcipotriene (Dovonex). 

• Light therapy (phototherapy): Ultraviolet light is delivered to the skin in a controlled setting. This is usually done in your doctor’s office.

• Systemic treatments: For more severe vitiligo, these are stronger medications given as pills. They’re more likely to have more side effects. Examples include prednisone and methotrexate.

• Surgery: There are different types of surgery. They usually involve removing small pieces of unaffected skin and putting them into vitiligo patches. This can be an option when other treatments don’t work.

• Sunscreen: Daily sunscreen is a must if you have vitiligo. This protects your skin from sunburn, which can make vitiligo worse and increase your risk of skin cancer. 

Many people with vitiligo also use camouflage creams. They come in different shades and blend in with unaffected skin. They don’t treat vitiligo, but they can reduce feelings of self-consciousness and improve quality of life for some. If you want ideas for vitiligo camouflage products, take a look at what has worked for some people with vitiligo. 

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Kerry R. McGee, MD, FAAP

Kerry McGee, MD, FAAP, has over a decade of experience caring for babies, children, and teenagers as a primary care pediatrician. She has a special interest in adolescent health, particularly in adolescent mental health.

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Images used with permission from VisualDx (www.visualdx.com).