Vitiligo: symptoms, causes & treatment

Vitiligo is a skin condition where your body breaks down melanocytes, the cells that produce pigment. Pigment gives your skin, hair and eyes their color. When these cells disappear, white patches are created where the pigment is missing.

The disorder occurs in approximately 0.5 to 2 percent of the population. In Belgium, around 55,000 to 220,000 people live with vitiligo. Men and women are equally likely to get vitiligo. Half of the people have the first spots before the age of twenty, and 70 to 80 percent before the age of thirty.

The exact cause has not yet been fully elucidated. The most accepted explanation is that vitiligo is an autoimmune disorder in which your immune system accidentally produces antibodies against your own pigment cells. Your immune system mistakenly sees these cells as intruders and tries to destroy them. Another theory is that a protective factor is missing, which makes the pigment cells vulnerable and die due to oxidative stress. Heredity certainly plays a role. If one of your parents or siblings has vitiligo, you're more likely to develop it too. Important to know: vitiligo is absolutely not contagious.

The process by which vitiligo develops takes place at the microscopic level. The melanocytes are gradually broken down and disappear from the affected skin areas. This does not happen suddenly, but develops over time. In most people, vitiligo starts with a few small, white spots that gradually enlarge. The pace varies enormously from person to person. In some, it is limited to a few small spots; in others, the spots spread over large areas of the body.

Various factors can trigger or aggravate vitiligo. Skin damage is an important trigger, such as burns, abrasions, or severe sunburn. This is called the Koebner effect. Stress is often mentioned as a trigger, where spots appeared or worsened after periods of intense emotional or physical tension. Pregnancy, illness, infections and contact with certain chemicals such as phenols in rubber can also play a role in sensitive people.

The course of vitiligo is unpredictable. In most people, the spots spread gradually over the years, often in periods of active phases alternating with stable moments. Spontaneous improvement occurs but is rare. Sometimes spots in sun-exposed areas partially regain their pigment, especially on the torso and arms, but almost never on the hands, feet, lips or face. Vitiligo is a chronic condition that usually increases in size and number without treatment.

The most characteristic symptom is the milky white skin patches themselves. These are very sharply defined with a clear contrast between the white spots and your normal skin color. The edges are often slightly darker than the surrounding skin. Vitiligo causes almost no physical symptoms. The spots don't hurt or itch. There is no scaling, redness, or swelling.

There are, however, a few practical disadvantages. The skin on the vitiligo spots lacks protection from sunlight. Without melanin, white skin burns extremely easily. This means that you have to be extra careful in the sun and always use good sun protection. On hairy parts of your body, the hairs also turn white in affected areas, such as eyebrows, eyelashes, beard, or scalp hair.

The psychosocial impact is often the biggest problem. The visible change in your appearance can have a huge impact on your self-esteem and self-confidence. Many people experience the spots as annoying, especially when they sit in highly visible areas such as the face, hands, or arms. People with vitiligo are sometimes stared at or asked questions from strangers. Unfortunately, children are regularly bullied at school. The emotional impact can lead to feelings of shame, social isolation, and even depression. Some people avoid social situations or clothing that shows their skin, which can significantly affect their quality of life.

Another aspect is the increased risk of other autoimmune diseases. Thyroid disorders, in particular, are more common in people with vitiligo. Other autoimmune diseases such as type 1 diabetes can also occur more frequently, although fortunately these combinations are rare.

Vitiligo can occur anywhere on your body where there are pigment cells, but there are clear preferred locations. The hands and feet are commonly affected, especially the tops of the hands, fingers, feet, and toes. The skin between fingers and toes may also develop white patches. Because our hands are so visible in social interactions, many people experience vitiligo as particularly disturbing here.

The face is another prominent location with a major psychosocial impact. Vitiligo often appears around the mouth, on the lips, around the eyes and eyelids, and around the nose. Facial vitiligo often has the biggest emotional impact because the face is always visible and at the center of social interactions.

On the torso, spots often occur around the navel and nipples, with patches that develop concentrically around them. Furthermore, spots can spread over the chest, stomach and back. The armpits and groin area are also commonly affected. These skin fold areas appear particularly sensitive, possibly due to the combination of friction, moisture and heat.

A distinctive feature is that spots often occur symmetrically. A spot on your left wrist is often accompanied by a spot on the same spot on the right. This bilateral symmetry helps physicians recognize vitiligo. The elbows and knees are also sensitive locations, possibly due to the mechanical stress that these areas undergo.

Segmental vitiligo is a specific form that behaves differently. Here, spots are limited to one side of the body and usually one part of the body, for example only the left cheek. This form expands shortly after it is created and then comes to a standstill. In generalized vitiligo, spots can spread all over the body. In extreme cases, almost the entire skin becomes white, which is called universal vitiligo.

It is important to look at treatment with realistic expectations. There is no treatment that completely cures vitiligo. The lost pigment cells cannot simply return. However, there are various treatments that can improve appearance and stimulate repigmentation. Not everyone with vitiligo opts for treatment. Because the condition does not cause physical symptoms, treatment is primarily a personal choice.

Skin camouflage with cosmetic products is the most simple and immediately effective approach. Special waterproof camouflage products can cover the white spots so that they are less noticeable. Available in a range of skin tones, these products stay put even when sweating or swimming. Some hospitals have skin camouflage departments where you get professional guidance.

Creams based on anti-inflammatory agents can stimulate repigmentation. These creams suppress the immune system locally, reducing the attack on pigment cells and giving remaining pigment cells the chance to recover. Results vary widely and it works better with fresh stains than with old ones. This treatment requires patience, as it takes months to see an effect.

Light therapy is an important treatment option for more extensive vitiligo. Your skin is exposed to specific wavelengths of ultraviolet light under controlled conditions. You receive these treatments twice a week in the hospital or with a specialist skin doctor. It is a long-term treatment that must be maintained for months to years for optimal results. After about a year, 75 percent of people see an improvement in 60 percent of their blemishes. Light therapy works best on the torso and arms, less so on the hands, feet and face.

Pigment cell transplants are a radical option where healthy skin containing pigment cells is transplanted from an unaffected area to white patches. This works best with stable, localized vitiligo that doesn't spread for a long time. The technique is complex and only available in specialized centers. For people with very extensive vitiligo, the reverse method exists, where the remaining normal skin is bleached so that everything gets one color. This is a drastic, irreversible choice that is only considered with universal vitiligo.

Referral to a dermatologist is important when considering treatment. The dermatologist can determine the best treatment strategy based on the extent, location, and activity of your vitiligo. Psychological support can also be valuable in terms of emotional impact.

Unfortunately, there are many misconceptions about vitiligo, and it's important to know what doesn't work to avoid disappointment and wasted time and money. There are no miracle cures that claim to cure vitiligo. If you come across products online that promise to make your vitiligo disappear completely, be extremely skeptical. There is no cream, pill, or natural remedy that can cure vitiligo, scientifically proven.

Dietary supplements and vitamins are sometimes touted as a treatment. While a healthy diet is important for your overall health, there is no evidence that specific supplements can treat vitiligo or stimulate repigmentation. Alternative therapies such as homeopathy, acupuncture, or ayurvedic treatments have no scientific evidence of effectiveness. Always talk to your doctor first if you want to try these.

Sunbathing or using a tanning bed without medical supervision is not recommended and can be dangerous. White skin burns extremely easily because it lacks protective melanin, and you increase your risk of skin cancer significantly. Light therapy should be done under the guidance of a dermatologist with the appropriate equipment and dosage. Stopping treatment as soon as you see first results is a common mistake. Repigmentation is a slow process that takes months. Always discuss with your doctor how long a treatment should last.

‍Is vitiligo contagious?

No, vitiligo is definitely not contagious. You can't contract it through touch, swimming, or other forms of contact. Vitiligo is not an infection but an autoimmune disorder in which your own body breaks down pigment cells. There is no risk of contracting vitiligo through contact with someone who has the condition.

Can vitiligo heal completely?

No, there is currently no cure for vitiligo. The condition is chronic and lasts for life. However, there are treatments that can improve appearance and stimulate repigmentation. Some people experience spontaneous improvement, but this is unpredictable and usually not complete. Researchers are continuously working on new treatments that may be more effective in the future.

Are there foods that affect vitiligo?

There is no evidence that specific foods aggravate or improve vitiligo. A healthy, varied diet is good for your general health, but special diets are not necessary for vitiligo. Don't be tempted by dietary advice that claims to treat vitiligo through food, as this is not scientifically substantiated.

Can I go out in the sun with vitiligo?

Yes, but with extra caution. The white patches lack protective melanin and burn extremely easily, often within minutes in the bright sun. Always use sunscreen with at least SPF 30 on all white areas, reapply regularly, wear protective clothing, and avoid the sun during the hottest hours between 12 and 15 p.m.

Does vitiligo get worse during pregnancy?

Pregnancy may trigger or worsen vitiligo through hormonal changes, although this does not happen to everyone. Every woman reacts differently. Vitiligo does not affect your fertility or your baby's health. Discuss treatment options with your doctor, as some treatments are not appropriate during pregnancy.

How can I help my child with vitiligo?

Open communication is essential. Explain what vitiligo is and emphasize that it is not contagious and does not hurt. Help your child build confidence by focusing on all the positive aspects and talents. Talk to school about the condition to prevent bullying. Consider reaching out to peer groups where your child can meet other children with vitiligo. Psychological support can be valuable if your child has difficulty with acceptance.

1. Skindr dermatologists
2. Health & Science, Vitiligo
3. UZ Gent, Vitiligo Patient Folder
4. UZ Leuven, Vitiligo Patient Folder
5. Huidziekten.nl
6. Vitiligo patient information | eBPNet