Brief overview
- Symptoms: Isolated or extensive white (depigmented) skin patches all over the body or only in individual areas (face, hands, feet), white coloration of hair possible, sometimes itching with new patches
- Treatment: medication such as cortisone, light therapy, PUVA (psoralen plus light therapy), bleaching, transplantation of pigment cells (melanocytes), relapse prevention by avoiding stress and intensive sun protection
- Causes and risk factors: Not fully known, probably autoimmune disease; genetic predisposition, stress, sunburns, skin irritations are risk factors; greatly increased risk of skin cancer in depigmented areas
- Prognosis: Not curable, but easily treatable, vitiligo progresses if left untreated; once spots have developed, they usually remain permanently
What is vitiligo?
In Europe, around one percent of the population suffers from white spot disease. There are no differences between men and women. It is striking that the disease predominantly appears before the age of 20.
There is also a familial clustering: in 30 percent of patients, another family member suffers from vitiligo. Vitiligo sufferers are also more likely to develop other autoimmune diseases such as autoimmune thyroiditis (Hashimoto’s thyroiditis), neurodermatitis or type 1 diabetes mellitus.
Vitiligo mainly affects young people. Depending on when the white spot disease first appears, a distinction is made between two different types:
- The rarer type 1 vitiligo begins before puberty. Many of those affected also suffer from neurodermatitis. In addition, young patients usually have many moles (halo nevi) and gray hair in places.
- Type 2 vitiligo begins after puberty. It accounts for around 85 percent of all cases of white spot disease. In contrast to type 1 vitiligo, type 2 is not accompanied by increased moles, neurodermatitis or gray hair.
In localized vitiligo, only isolated white patches appear.
In generalized vitiligo, several parts of the body are usually affected over a large area:
Vitiligo vulgaris, the most common form of white spot disease, is one of the subtypes of generalized vitiligo. This involves the formation of large white patches in various areas. In most cases, the respective sides of the body are affected in parallel (non-segmental vitiligo).
The white spot disease rarely spreads to mucous membranes and scalp hair.
How does vitiligo manifest itself (in the early stages)?
Typical of white spot disease is the white coloration (depigmentation) of the skin: in the early stages, spots appear in more or less numerous places that are only slightly pigmented or not pigmented at all (i.e. white). They are a few millimeters to centimeters in size, round or oval. Their edges are irregular, but stand out sharply from the surrounding skin. In some cases, the white patches merge into one another and then form so-called foci.
In some patients, the hair that grows on the pigment spots also loses its color. The appearance of a new spot is accompanied by itching in some patients.
How is vitiligo treated?
The disease itself is currently not considered curable. However, treatment can halt the progression of the disease and prevent new relapses. The best specialist to contact for treatment is a dermatologist.
Strongly covering cosmetics such as camouflage make-up can effectively conceal any annoying light spots.
Vitiligo can also be treated with special medication and phototherapy.
In a few cases, however, the spots disappear completely on their own.
Drug therapy
Phototherapy and PUVA
Phototherapy is an alternative or additional treatment option. This can achieve good results in vitiligo therapy: The white patches of skin are specifically irradiated with UV-B light of a certain wavelength. It is assumed that this stimulates the growth of the pigment cells.
Further treatment options
In the case of very pronounced, generalized vitiligo, bleaching the skin may be the last treatment option: the unaffected areas of skin are chemically bleached to match the shade of the white patches. But beware: the result is not always uniform. It is also permanent and cannot be reversed. The skin type also plays a role in terms of the result and feasibility.
Naturopathically, ginkgo extract is considered a possible treatment for white spot disease. According to some studies, it promotes skin repigmentation in some patients.
In connection with the disease, much of which has not yet been researched, some circles are also discussing the topic of nutrition. Vitamin C, B12 or folic acid, for example, are considered to be possible important factors in the diet – but so far without a proven link.
Causes and risk factors
Exactly how and why vitiligo develops has not yet been conclusively clarified. However, doctors suspect that it is an autoimmune disease: The immune system acts against the body’s own structures due to a malfunction. In the case of white spot disease, this involves the pigment cells (melanocytes) in the skin. The melanocytes produce the pigment melanin and release it into the surrounding skin cells. The more melanin there is in the skin, the darker it is.
Risk factors and triggers
The risk of white spot disease appears to be genetic. Familial clusters suggest this connection. The most important trigger for acute flare-ups is stress: both physical (such as an infection) and psychological stress often promote the development of further white spots. Sunburns and local skin irritations, such as those that occur as part of psoriasis, also trigger vitiligo in many cases.
Examinations and diagnosis
- When did you first notice the skin changes?
- Where are the spots located and how large are they?
- Are other family members affected?
- Do you have any other illnesses (diabetes mellitus, neurodermatitis or similar)?
- Do you take medication regularly?
- Did you suffer from severe sunburn or other skin diseases or irritations before the onset of the disease?
Physical examination
The doctor also examines the white skin spots using a special UV lamp, known as Wood light (wavelength: 364 nm). In this light, the vitiligo spots glow white-yellow.
To confirm the diagnosis, healthy areas of skin can be mechanically irritated with a wooden stick. If it really is a case of white spot disease, new pigment spots will appear on the irritated area. This effect is known as the Köbner phenomenon.
Further examinations
If the laboratory values show abnormalities, further examinations are carried out to clarify the diagnosis.
Differential diagnoses
The various tests are not only used to diagnose vitiligo. They also help to rule out other diseases that cause similar skin changes. These so-called differential diagnoses in white spot disease include other pigment disorders and skin diseases such as certain forms of moles (naevus depigmentosus, naevus anaemicus), piebaldism, hypomelanosis guttata and pityriasis versicolor alba.
Disease progression and prognosis
Further information
Self-help:
- German Vitiligo Association: https://www.vitiligo-bund.de/
- German Vitiligo Association e.V.: https://www.vitiligo-verein.de/
