People who develop vitiligo usually first notice white patches (depigmentation)
on their skin. These patches are more commonly found on sun-exposed areas of the
body, including the hands, feet, arms, face, and lips. Other common areas for
white patches to appear are the armpits and groin, and around the mouth, eyes,
nostrils, navel, genitals, and rectum.
Vitiligo generally appears in one of three patterns:
focal pattern -- depigmentation limited to one or only a few areas
segmental pattern -- depigmented patches that develop on one side of the body
generalized pattern -- the most common pattern. Depigmentation occurs
symmetrically on both sides of the body.
In addition to white patches on the skin, people with vitiligo may have
premature graying of the scalp hair, eyelashes, eyebrows, and beard. People with
dark skin may notice a loss of color inside their mouths.
Will the depigmented patches spread?
Focal pattern vitiligo and segmental vitiligo remain localized to one part of the body and do not spread. There is no way to predict if generalized vitiligo will spread. For some people, the depigmented patches do not spread. The disorder is usually progressive, however, and over time the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly, over many years. For other people, spreading occurs rapidly. Some people have reported additional depigmentation following periods of physical or emotional stress.
How is vitiligo diagnosed?
The diagnosis of vitiligo is made based on a physical examination, medical
history, and laboratory tests.
A doctor will likely suspect vitiligo if you report (or the physical
examination reveals) white patches of skin on the body-particularly on
sun-exposed areas, including the hands, feet, arms, face, and lips. If vitiligo
is suspected, the doctor will ask about your medical history. Important factors
in the diagnosis include a family history of vitiligo; a rash, sunburn, or other
skin trauma that occurred at the site of vitiligo 2 to 3 months before depigmentation started;
stress or physical illness; and premature graying of the hair (before age 35).
In addition, the doctor will ask whether you or anyone in your family has had
any autoimmune diseases and whether you are very sensitive to the sun.
To help confirm the diagnosis, the doctor may take a small sample (biopsy) of
the affected skin to examine under a microscope. In vitiligo, the skin sample
will usually show a complete absence of pigment-producing melanocytes. On the
other hand, the presence of inflamed cells in the sample may suggest that
another condition is responsible for the loss of pigmentation.
Because vitiligo may be associated with pernicious anemia (a condition in
which an insufficient amount of vitamin B12 is absorbed from the
gastrointestinal tract) or hyperthyroidism (an overactive thyroid gland), the
doctor may also take a blood sample to check the blood-cell count and thyroid
function. For some patients, the doctor may recommend an eye examination to
check for uveitis (inflammation of part of the eye), which sometimes occurs with
vitiligo. A blood test to look for the presence of antinuclear antibodies (a
type of autoantibody) may also be done. This test helps determine if the patient
has another autoimmune disease.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Addison disease is a hormonal (endocrine) disorder involving destruction of the adrenal glands (small glands adjacent to the kidneys). Diseased glands can no longer produce sufficient adrenal hormones (specifically cortisol) necessary for normal daily body functions. Symptoms include weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin. Treatment of Addison disease involves replacing, or substituting, the hormones that the adrenal glands are not making.
Tinea versicolor is a fungus infection that mainly affects the skin of young people. Recognized by light or reddish brown spots, and areas lighter than the surrounding skin. Tinea versicolor is caused by yeast actually found in our skin. Factors like heat, humidity, and sweat help it proliferate in people, resulting in a rash that is not contagious to others.
Pernicious anemia is a blood disorder in which the body does not make enough red blood cells due to a lack of vitamin B12 in the blood. Pernicious anemia can develop from a lack of a protein that helps the body absorb vitamin B12, not getting enough B12 in the diet, and certain intestinal conditions that interfere with the absorption of vitamin B12 such as Crohn's disease, celiac sprue, or ulcerative colitis. There is no cure for pernicious anemia, thus treatment is life-long.
Alopecia areata is a condition that causes hair loss on the scalp and sometimes other parts of the body. It is believed to be caused by an abnormality of the immune system that causes the body's immune system to attack the hair follicles. Typically, hair regrows within a year without treatment. Steroid injections, creams, and shampoos may be used during treatment.
Birthmarks and other abnormal skin pigmentation is caused by the body's inability to produce enough melanin. Abnormal skin pigmentation can cause conditions such as vitiligo, pigmentation loss, melasma, albinism, port wine stains, macular stains and hemangioma.
Graves' disease is an autoimmune disease that affects the thyroid. Some of the symptoms of Graves' disease include hand tremors, rapid heartbeat, trouble sleeping, enlarged thyroid, thinning of the skin or fine brittle hair. Causes of Graves' disease are thought to be multifactorial such as genes, gender, stress, and infection. Treatment for Graves' disease is generally medication.
Uveitis is inflammation of the eye. Symptoms include blurred vision, eye pain, eye redness, and floating spots before the eyes. Treatment may involve prescription eyedrops, antibiotics, and wearing dark glasses.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
Stiff-Person syndrome is a neurological disorder associated with features of an autoimmune disease. Signs and symptoms of Stiff-Person syndrome include a heightened sensitivity to stimuli (noise, touch, emotional distress) and fluctuating muscle rigidity of the trunk and limbs. Conditions associated with Stiff-Person syndrome include thyroiditis, vitiligo, pernicious anemia, and diabetes. Treatment for Stiff-Person syndrome is generally medication to control symptoms.
Parry-Romberg syndrome is a rare disorder that is characterized by a slow progressive atrophy of the skin and soft tissues of half of the face. The facial changes generally begin between the ages of 5 and 15 years. There is no treatment or cure for Parry-Romberg syndrome.
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