Definition

     Vitiligo is a skin condition in which there is loss of pigment (color) from areas of skin, resulting in irregular white patches that feel like normal skin.

Causes

• Vitiligo is due to a problem with melanocytes, the cells in the skin that carry color.  In the regions where the skin is lighter, there is a lack of these special cells.

Symptoms

• The affected areas appear as "white" or "pale" patches of skin.

• Usually it does not cause any symptoms.

• It mostly affects the person's appearance cosmetically.

• However, these areas are more sensitive to sunlight and burn easily, which may eventually lead to skin cancer.

Screening and Diagnosis

• Examination -- the doctor may easily recognize the typical "white patches" of discolored skin.

• If needed, a special light may be used to examine the suspected area, or the doctor may choose to examine a scraping of the skin under a microscope.   If the diagnosis is still not known, a biopsy may be in order.

Treatment

• Treatment for Vitiligo is difficult.  Treatment is primarily to help with the cosmetic appearance.

• Cosmetic makeup such as Covermark or Dermablend may be used to cover the "white" areas.

• If less than 20% of the skin surface is involved, a medicated cream with Methoxsalen may be applied and the area is exposed to ultraviolet light.  The medicine is then washed off.  People treated with this medicine must use a SPF 15 sunscreen when outdoors.

• If more than 20% is involved, Methoxsalen is given by mouth, followed by treatment with ultraviolet light.  Patients must be careful outdoors, as severe sunburns may result from Methoxsalen use.

• This treatment is best for the face and chest.  Fingertips and genital areas do not respond well.

• Years of therapy may be needed.

• Some patients have been treated with large doses of steroids to good effect.

• Newer, more promising surgical treatments are being studied.

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.