Why might this happen? “It is believed to be an autoimmune condition where the body’s immune system destroys the melanocytes, resulting in white patches,” says Michele Green, MD, a dermatologist in private practice in New York City. Anyone can potentially develop vitiligo. It affects men and women of all races and ages, though in most cases the white patches associated with vitiligo start to show up before one’s 20th birthday. (3,4) Suzanne Friedler, MD, a dermatologist at The Mount Sinai Hospital in New York City, says about half of vitiligo cases begin by the age of 20. (5) The vitiligo spots can occur anywhere on the body. (4) Usually, though, the patches will start in places that have been exposed to the sun, such as the hands, feet, arms, and face. They also tend to appear in the armpits, groin area, or in the belly button. (5) Some people — especially those with dark skin — might also experience vitiligo inside their mouths, and their mouths may lose color. It’s also possible for vitiligo to affect the hair. These patients might experience early graying or whitening. This can affect not only the hair on the head, but eyebrows and eyelashes as well. The retina in the eye could also lose color. (4) These spots typically first appear as paler-than-normal patches of skin that gradually turn slightly pink (when the body’s immune system is attacking the healthy melanocytes) and then, in many cases, almost completely white. (6) Some treatments may be more effective early on when the skin first starts to lose its pigment. (7) It’s also worth noting that the white patches associated with vitiligo differ depending on the type of the disorder:
Segmental Vitiligo People who develop vitiligo at a young age usually experience it on one side of the body, which is called segmental vitiligo. For these people, the disease will usually spread for one or two years and then halt. (4)Localized or Focal Vitiligo This is vitiligo that affects just a few parts of the body.Generalized Vitiligo The most common type of vitiligo, this results in the white patches appearing in the same area on each side of the body. (4)
It’s impossible to say how widespread any one case of vitiligo will be. (4) “Sometimes skin can spontaneously repigment, but just as often the loss of skin color can spread,” Dr. Friedler says. Treating the vitiligo can help bring color back to the affected area or make the vitiligo less noticeable, but it won’t stop the vitiligo from spreading, or prevent white patches from developing elsewhere. Currently there is no cure that can stop or reverse vitiligo. (4) However, there are new treatments that can safely and effectively bring pigmentation back in some individuals. In addition, there are some things that can make the pigment loss that vitiligo causes worse. Sun damage is one, which is why experts recommend people with vitiligo apply a broad-spectrum, water-resistant sunscreen with SPF 30 or higher. (4) Wearing sunscreen also helps keep the skin from tanning, which will minimize how different the vitiligo-affected skin looks compared with the normal skin. There are over 30 genes that are associated with it. (8) Variations in two genes in particular — NLRP1 and PTPN22 — play a role in increasing the risk because they can lead to inflammation and cause the immune system to attack the body’s tissues mistakenly. (8) There then needs to be a triggering event that causes the immune system to attack the body’s melanocytes. Potential triggers include: (8)
Ultraviolet radiation, which can come from the sun, tanning beds, mercury lamps, UV sanitizing bulbs, or welding torches (9)Exposure to certain chemicalsStress
Therefore, it’s a combination of both genetics and environmental factors (most of which researchers have not yet identified) that lead to vitiligo. (8) And the same environmental triggers that can set off vitiligo in the first place — such as being exposed to industrial chemicals — could also cause vitiligo to worsen. (4)
Eye Issues People with vitiligo may experience inflammation in the iris, which is called iritis.Hearing Problems People with vitiligo may lose part of their hearing, which is called hypoacusis.Sunburn Melanin helps protect the skin from some of the sun’s dangerous ultraviolet rays. (10) Because people with vitiligo have white patches on the skin that lack melanin, they may be more susceptible to the effects of the sun and are at risk of getting a sunburn. (4)
One of the most pronounced side effects of vitiligo is the emotional distress that usually accompanies the diagnosis. How intense and troubling the diagnosis is can depend on how widespread the condition is and where it appears on the body. (4) “Loss of pigmentation can be emotionally distressing, especially in darker pigmented people because it is more noticeable in those patients,” Friedler says. Anxiety and depression are a concern as well, so many people with vitiligo find it beneficial to meet with a psychotherapist or another mental health professional for ideas of how to cope. (3)
