Vitiligo is a skin disorder characterised by white patches of skin that have little or no pigment (melanin). In these patches there are no pigment cells (melanocytes). It's not clear why, but evidence suggests that the body’s immune system attacks and destroys them. With one in 100 people in the UK developing vitiligo, it’s a fairly common skin condition that can be successfully treated.
We asked Dr James Milne, consultant dermatologist at Gloucestershire Royal Hospital, what he would want to know if he was diagnosed with vitiligo.
Can vitiligo be cured?
No, but there are treatments that can help. If you have vitiligo, your immune system is probably destroying the pigment cells in certain areas of your skin. Steroid creams and other anti-inflammatory treatments can suppress the immune response in those areas, and ultraviolet light can be used to stimulate the pigment to return. We cannot switch off the immune response that damages the skin and so cure is rare.
What is depigmentation therapy?
Depigmentation therapy is another treatment option, but it’s reserved for people who have large areas of depigmentation (loss of pigment) and is not widely available. A lotion is painted on to the normal skin to bleach away the pigment and make it the same colour as the depigmented skin. A hydroquinone-based medication is used, which has many side effects and has to be applied continuously to avoid the skin repigmenting.
Will my children inherit my vitiligo?
About a third of people with vitiligo have a family history of this disease. However, because there is no specific gene causing vitiligo, we cannot be accurate about the chance of a family member getting it.
Parts of my skin have repigmented spontaneously. Will they stay like this forever?
Most people with vitiligo who tend to tan well will repigment up to 20% of their skin spontaneously, especially during summer. This may decrease again when the tan fades.
Is there anything I can do to stop my depigmentation from getting worse?
Not really. The treatments mentioned may stop it from progressing, but may not stop new areas from depigmenting. Many will find that a treatment works, but that the pigment is lost once the treatment stops.
Will I lose my hair colour?
If vitiligo occurs on the scalp skin, some of the hair follicles may lose their pigment and the patch of hair will appear white. This is known as poliosis. Skin treatments can help the hair to pigment, but it’s often difficult to get them into the areas that produce the hair. Dyeing the affected hair will not make the vitiligo worse.
Is sunbathing a good idea?
As a dermatologist, I would encourage everyone to avoid sunbathing and cover their skin with appropriate clothing and sunscreen in order to reduce their risk of skin cancer. People with vitiligo have a lower risk of developing skin cancer, even though they lack the protective pigment in certain areas. The patches of vitiligo will burn more easily and age prematurely, so it’s important to be very careful in the sun. And of course, stopping the normal skin from tanning by using sunscreens will make the vitiligo much harder to see.
Are there any areas of skin that are harder to treat than others?
The more pigment in the skin, the more likely the treatment will work. This means that people with dark skin may respond well to treatment, whereas pale skin often doesn’t respond. The face and neck respond best to treatments, while the hands and feet usually respond poorly. Some people get vitiligo on their genitals, and these too can be treated with creams, although it’s not safe to use UV light.
