Vitiligo affects people of all ethnic groups and often begins before the age of 30. It is not contagious, not painful and not a form of leprosy. Although it does not usually affect a person’s general physical health, it can have a significant emotional and social impact.
Types of Vitiligo
Non-Segmental Vitiligo
This is the most common form. White patches usually appear on both sides of the body, often in a symmetrical pattern, and may gradually spread over time.
Segmental Vitiligo
Segmental vitiligo affects one side or one area of the body. It often starts at a younger age, spreads for a limited period and then becomes stable.
Focal Vitiligo
Focal vitiligo causes one or a few small patches in a limited area of the body.
Causes and Risk Factors
Vitiligo is mainly considered an autoimmune condition, in which the immune system attacks the body’s own pigment-producing cells.
Factors associated with vitiligo include:
Family history: Around 1 in 5 people with vitiligo has a relative with the condition.
Other autoimmune diseases: Especially thyroid disease, type 1 diabetes, pernicious anaemia and alopecia areata.
Emotional stress
Sunburn
Skin injury or repeated friction
New patches can sometimes appear at sites of cuts, rubbing or injury.
Vitiligo is not caused by diet. Beliefs that combinations such as fish with milk or sour foods cause white patches are not supported by scientific evidence.
Symptoms
The main symptom is the appearance of milky-white patches of skin.
Commonly affected areas include:
Face
Around the mouth and eyes
Hands
Feet
Elbows
Knees
Genital area
Other possible features include:
Premature whitening of hair on the scalp, eyebrows, eyelashes or beard
Loss of colour inside the mouth or nose
Increased sensitivity to sunlight in affected areas
The course of vitiligo is unpredictable. Patches may remain stable for years, spread slowly or, less commonly, regain some colour without treatment.
Diagnosis
A dermatologist can usually diagnose vitiligo by examining the skin.
Tests may include:
Wood’s lamp examination: Ultraviolet light can make vitiligo patches appear bright white and help identify early or subtle areas.
Skin biopsy: Rarely needed, but may be used when the diagnosis is uncertain.
Blood tests: Thyroid function and blood sugar tests may be advised because vitiligo is associated with other autoimmune conditions.
Treatment
Treatment aims to stop the condition from spreading and restore skin colour where possible.
Results vary between individuals. The face and neck often respond better, while areas such as the hands, feet and lips may respond less well.
Topical Corticosteroids
Steroid creams may be used for small or recently developed patches.
Topical Calcineurin Inhibitors
Medicines such as tacrolimus and pimecrolimus may be used, particularly on sensitive areas such as the face and skin folds.
Topical Ruxolitinib
Ruxolitinib is a JAK inhibitor cream that may be used for certain cases of non-segmental vitiligo.
Phototherapy
Narrowband UVB phototherapy is commonly used for more widespread vitiligo and is usually given several times a week.
A targeted excimer laser may be used for smaller areas.
Oral Medicines
Short courses of low-dose oral corticosteroids may sometimes be used to help slow rapidly spreading vitiligo.
Surgical Treatment
Skin or cell grafting may be considered for stable vitiligo that has not changed for at least a year, particularly in segmental disease.
Depigmentation
For very extensive vitiligo, the remaining pigmented skin may rarely be lightened to create a more even skin tone. This approach is permanent and is used only in selected cases.
Living With Vitiligo
White patches contain less protective pigment, so they can burn more easily in the sun.
Helpful measures include:
Using a broad-spectrum sunscreen with SPF 30 or higher
Wearing protective clothing
Avoiding unnecessary friction or injury to the skin
Using cosmetic camouflage products if desired
Using self-tanning products to reduce contrast between affected and unaffected skin
Vitiligo can also affect self-confidence and emotional wellbeing. Counselling and support groups may help people manage the psychological and social impact.
In India, vitiligo may carry social stigma, particularly around marriage. Accurate information is important: vitiligo is not infectious, not caused by food and not inherited in a simple predictable way.
When to See a Doctor
See a dermatologist when:
New white patches appear
Existing patches begin spreading quickly
The diagnosis is uncertain
The condition is affecting confidence or daily life
Early medical assessment may improve the chance of slowing progression and restoring some pigment.
The Bottom Line
Vitiligo is a chronic autoimmune skin condition that causes loss of pigment in patches of skin. It is not contagious and not caused by diet or poor hygiene.
Although there is no guaranteed cure, treatments such as topical medicines, phototherapy and selected surgical approaches can help restore colour or slow progression in some people.
