Vitiligo

Vitiligo is a chronic skin condition with white patches that develops when the cells that give the skin its colour — the melanocytes — are targeted by the immune system. Although it can be seen at any age, in most patients it begins in childhood or young adulthood. The condition is not contagious and does not pass from person to person by contact.

The most prominent finding in vitiligo is the appearance of milky-white patches with usually sharp borders. The face, area around the lips and eyes, hands and feet, elbows, knees, underarms and genital area are most often affected. In areas where the scalp is involved, whitening of the hair, eyebrows, eyelashes or beard can also be seen.

Although the exact cause is not fully known, the most widely accepted mechanism is an autoimmune process. Genetic predisposition plays an important role, and some patients also have thyroid disease, type 1 diabetes, pernicious anaemia or other autoimmune conditions. Additional assessments may therefore be planned in patients where needed.

In some people vitiligo remains limited to the same areas for many years, while in others new patches develop. Stress is an important trigger. Skin trauma and friction can trigger new lesions in some patients; this is called the Koebner phenomenon.

The diagnosis is usually made by dermatological examination. Where needed, Wood's lamp examination helps assess the vitiligo areas more clearly and determine the extent of the condition. Rarely, a skin biopsy may be needed for the differential diagnosis from other white-patch conditions.

Treatment is planned individually according to the extent, location, duration and activity of the condition. Topical treatments, phototherapy (narrowband UVB), certain lasers and, where necessary, systemic treatments may be used.