Vitiligo (a disorder that causes pigment loss in the skin and other parts of the body) doesn’t pose a major threat to your health, and it’s not usually painful or itchy, but receiving a diagnosis could bring you peace of mind and help you understand what’s happening to your skin. (2) “Scheduling an appointment with your dermatologist is the best way to diagnose vitiligo,” Hal Weitzbuch, MD, a dermatologist in private practice in Calabasas, California. At your appointment, your doctor may ask about: (1,2)
The history of the patches. Expect questions such as: When did they first appear? Have they been spreading or staying in one area?Your health history. The doctor will likely be interested in hearing if you have been diagnosed with an autoimmune disease.Family history of vitiligo. Vitiligo tends to run in families. In fact, about 20 percent of people with vitiligo also have one or more close relatives with the same issue.Any recent stressful events. A doctor may ask about recent events that have stressed you out physically or emotionally, such as life changes or severe sunburns.
Here are some questions that might be helpful for you to ask your doctor at your appointment: (1)
What’s causing these symptoms?Will this condition last forever?What are my treatment options?What are the potential side effects of these treatments?Are there any lifestyle changes you recommend I make?
It’s usually easy to see the patches on dark skin. But for lighter-skinned people where there’s less distinction between the affected skin and unaffected skin, the doctor might use a tool called a Wood’s lamp, which shines ultraviolet light. Skin with vitiligo will look different under this type of light. (2) The tool can also be used to distinguish loss of pigment versus a reduction in color (which may be the sign of an inflammatory rash). (3) Appearance, along with the answers to those questions about your medical history, are usually all it takes to be diagnosed, though some doctors may recommend additional tests to be sure. A skin biopsy, for instance, will show whether melanocytes are present. A lack of melanocytes can confirm a vitiligo diagnosis. (2) The skin biopsy can also indicate whether or not you’re dealing with a skin cancer called hypopigmented cutaneous T-cell lymphoma. Some doctors will recommend a blood test to see if the vitiligo is related to an underlying autoimmune disease, such as anemia, thyroid dysfunction, or type 1 diabetes. (1) Blood test results are typically available within a week. (2)
Cosmetic Options
Dr. Green says some of the most effective ways to minimize the appearance of vitiligo include applying sunscreen regularly (which can help prevent the spread of vitiligo and lessen the contrast between your natural skin tone and discolored skin) and using makeup to cover the white spots. Self-tanning products may also help. (1) “A self-tanner stains the skin, so you can stain all the skin and camouflage a little bit of the vitiligo patches,” says Sandy Skotnicki, MD, a Toronto-based dermatologist and the author of Beyond Soap. “That’s a useful suggestion sometimes for people with fairer skin color, though it can be tricky to find the right shade.”
Medication
The medications available now don’t stop vitiligo from spreading, but they can in some cases restore some skin color. Anti-inflammatory corticosteroid creams have been shown to help, especially if you start using one soon after your diagnosis. It may take several months to notice a difference, and it may cause side effects, such as streaky-looking skin. (1) Topicals that contain the drugs tacrolimus (Prograf) or pimecrolimus (Elidel) can help vitiligo that affects small areas, such as the face or neck. (1) It’s important to note that the U.S. Food and Drug Administration says there could be a link between these medications and skin cancer and lymphoma. (1) However, this is more associated with oral administration and much less likely with topical application. In 2021, the FDA approved a new class of medications known as topical Janus kinase (JAK) inhibitors for the treatment of vitiligo. These medications block a protein that leads to inflammation and pigment cell destruction in the skin. The FDA-approved JAK inhibitor ruxolitinib (Opzelura) is applied as a cream twice daily to the affected areas for up to eight weeks. Ruxolitinib also comes with a strong warning, linking it to serious infections, major adverse cardiovascular events, clotting (thrombosis), cancer, and increase in death. Again, these side effects are predominantly seen with oral administration of this medication class. More commonly, redness of the skin and inflammation of the nasal passages can be seen. Ruxolitinib is also used to treat eczema and can be used for nonimmunocompromised patients ages 12 and above.
Light Therapy
Another way to treat vitiligo is through light therapy, or exposing skin to ultraviolet light to stimulate the growth of pigment-producing cells. It’s an effective treatment, though you may need to repeat the treatments three times a week for up to a year. (1). Your doctor may recommend combining light therapy with psoralen, which is a plant-derived medication that can help restore color to the area, though this increases the risk of developing a burn and a skin cancer in that area. Green says one type of laser in particular, the excimer laser, has been effective for treating vitiligo. One small study found that three patients with depigmentation on their face who were treated with the laser twice a week saw color return to 75 percent of the area after 10 to 20 weeks of treatment. (4) RELATED: Causes and Treatments of Psoriasis
Depigmentation
In some cases, depigmentation — a therapy that evens out the skin tone by removing pigment from skin that’s been unaffected — is an option. This treatment is usually needed one or two times per day for about nine months and tends to be the most helpful for people who have very widespread cases and haven’t had success with other treatment options. The change in your skin tone will be permanent. The skin will be sensitive to light going forward, and you may also experience dryness, itching, or swelling. (1)
Surgery
Some people turn to surgery if therapy doesn’t work, but most experts will only suggest surgical options once vitiligo is stable for more than one year. (1)
Skin grafting involves removing small sections of normally pigmented skin and attaching them to areas that have lost color.Blister grafting involves transplanting intentionally created blisters from areas of normally pigmented skin to areas where color is gone.Tattooing — though it may be difficult for a doctor to match the original skin tone exactly
All these options aim to bring color back to the skin. Tattooing is particularly helpful for people with dark skin who have vitiligo on their hands or in and around their mouths. There are some negative side effects to be aware of for each of these surgical options, such as scarring, skin that has a cobblestone appearance, and the potential triggering of vitiligo elsewhere on the body. (1) It’s also important to know that sometimes these treatments don’t stick, and new patches may appear even if it seems to be working well on existing ones. There’s also some evidence that supplementing with certain herbs and vitamins may help, such as the herb ginkgo biloba and alpha-lipoic acid, folic acid, vitamin C, and vitamin B12 when combined with phototherapy. (1) But Dr. Weitzbuch points out that the evidence is very limited. “A variety of vitamins and supplements have shown some benefit in small studies, but nothing has conclusively been shown to be very effective,” he says. And remember to check with your doctor before trying a supplement; some may interact with other medications you’re taking or result in unintended side effects.
