Vitiligo causes white patches to develop on the skin. It is due to a lack of pigment (colour) in the affected areas of skin. Vitiligo does not make you feel ill. However, the appearance of vitiligo can be distressing. This is particularly so for darker skinned people where white patches are more noticeable.

Who gets vitiligo?

About 1 in 100 people develop vitiligo. Men and women are equally affected. It can develop at any age. However, it begins before the age of 20 in about half of affected people. Vitiligo is not infectious and you cannot 'catch' it from affected people.

What causes vitiligo?

Normally there are cells called melanocytes just under the top layer of skin. These cells make a pigment called melanin which colours the skin. Fair skinned people make less melanin than dark skinned people. The melanin helps to protect the skin against sunlight. The melanocytes are stimulated when exposed to sunlight to make more melanin. This is how fairer skinned people develop a sun tan.

Areas of skin with patches of vitiligo have no or very few melanocytes. Therefore melanin cannot be made and the colour of the skin is lost. It is not known why the melanocytes go from affected areas of skin. They may be destroyed by the immune system or 'self-destruct' for reasons not yet known. There is some genetic factor involved and vitiligo may 'run in the family'. About 1 in 3 affected people have some other family member who is also affected. But 2 in 3 affected people do not have other family members affected so it is not just an inherited problem.

What areas of skin are affected with vitiligo?

Any area of skin can be affected. However, it is most common on the backs of hands, front of knees, neck, elbows and face. Hair may be affected too and lose its colour to become grey.

How does vitiligo progress?

Small areas of milky white skin usually develop first. The contrast between the vitiligo skin and normal skin varies. In fair skinned people it may only be noticeable in summer when normal skin tans. The contrast is more noticeable in darker skinned people.

The white patches are often symmetrical - that is they often look about the same on both hands, legs, etc. The course and severity of vitiligo varies from person to person. Sometimes a few small patches develop and progress no further. However, it is quite common for the white patches to gradually become bigger and for more patches to appear on other parts of the body. Large areas of the skin may eventually be affected. Sometimes a number of patches develop quite quickly and then remain static for months or years without changing. There is no way of predicting how much of the skin will eventually be affected when the first patch develops. The white patches are usually permanent. Rarely, some patches of vitiligo may re-pigment and return to normal.

What are the symptoms of vitiligo?

Affected people are normally well. Vitiligo is not sore or itchy.
Affected people are often distressed by the appearance of their skin, particularly if the face or hands are affected.
Sunburn - there is no natural protection from the sun in affected areas of skin. Vitiligo skin burns much more easily than normal skin if exposed to sunlight.

What are the treatments for vitiligo?

Medical treatment is often disappointing and skin camouflage is the usual way of dealing with vitiligo.

Sunblock
A high protection sun (factor 15 or above) should be applied to areas of vitiligo not covered by clothing. Sunburn can easily occur if the skin is not protected. Some sunblocks used for medical reasons such as for vitiligo are available on NHS prescription. Avoid the sun when it is strong to prevent burning.

No treatment
Some people may not be concerned about the white patches of skin if they are in areas not noticeable to others. In fair-skinned people, avoiding tanning of normal skin can make patches of vitiligo much less noticeable.

Steroid cream
This is sometimes prescribed when a patch of vitiligo first develops. It may prevent a smaller patch from getting bigger. Occasionally, skin colour may return over a treated area. However, the response to steroid cream is usually not very good. Also, steroid cream is usually only advised for a limited time as long term use can cause side effects.

PUVA treatment
PUVA stands for Psoralen and Ultra Violet A light. It involves taking a special medicine (a psoralen) which makes the skin very sensitive to light. The skin is then treated with ultra violet A light (UVA) from a special machine in hospital. This treatment works well in some people - perhaps up to half of affected people. However, it is very time consuming. Treatment is needed twice a week for 6-12 months or more. PUVA may also cause side effects such as 'sunburn' type reactions or skin freckling. There is also an increased risk of skin cancer with this treatment. It is not normally advised for children. If colour does return to the white patches there is still a chance that it may go again at a later stage.

Skin grafting
Grafting of normal skin to small patches of vitiligo has been tried. It is time consuming and not always successful or available.

Depigmentation treatment
In some people with extensive vitiligo a treatment may be considered to make the remaining normal areas of skin to go white. This makes all the skin an even white colour. This is done only after a full discussion with a specialist. The removal of all the skin pigment is permanent and it takes about a year to complete.

Skin Camouflage
Skin camouflage uses special coloured cover creams that are put on the white patches of vitiligo. Skin camouflage does not alter the disease but improves the skin's appearance. The aim is to find a colour to match the colour of your skin. Some special cover creams can be prescribed on the NHS. The cream can disguise vitiligo very well which may greatly increase self confidence. The British Red Cross provide a free Skin Camouflage Service (see below).

There are also products available from pharmacies often called 'fake tans'. These may also hide the vitiligo and can last several days before needing to be reapplied. However, they often do not provide an exact match for each skin colour. They may be most useful for large areas of vitiligo where matching the colour exactly to nearby skin is not needed so much.

Are there any complications of vitiligo?

Vitiligo itself does not develop into any other condition. However, other 'auto-immune' disorders are slightly more common in people with vitiligo than average. For example, thyroid problems and a type of anaemia called pernicious anaemia. Most people with vitiligo do not have these but your doctor may suggest a blood test to rule them out.

Further help and information

Vitiligo Society
125 Kennington Road, London, SE11 6SF
Tel: 0800 018 2631 Web: www.vitiligosociety.org.uk
Includes information and support for people with vitiligo and their families.

Red Cross Skin Camouflage Service
British Red Cross Association, 9 Grosvenor Crescent, London SW1X 7EJ
Tel: 020 7201 5173 Web www.redcross.org.uk
Aims to teach how to apply camouflage creams effectively and to enable people to feel more confident about their appearance. The service is available nationally. Clinics are usually held in the Skin Departments of hospitals, in GP surgeries, or in British Red Cross Branch offices. A letter of referral from a GP or specialist is needed before an appointment can be made.

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