What Is the Difference Between Vitiligo and Piebaldism?

Medically Reviewed on 7/7/2022
Difference Between Vitiligo and Piebaldism
Vitiligo is an autoimmune disorder although piebaldism is not.

Both vitiligo and piebaldism feature distinctive white skin patches caused by a complete lack of melanin in regions where melanin-producing cells, or melanocytes, are absent. 

Melanocytes are destroyed in vitiligo in early childhood or adult years, but they are absent from birth in piebaldism.

7 key differences between piebaldism and vitiligo

Seven differences between piebaldism and vitiligo include:

  1. Piebaldism is present at birth but not vitiligo.
  2. Piebaldism is caused by a mutation in the c-KIT gene, whereas vitiligo is caused by over 30 distinct genes (most notably NLRP1 and PTPN22).
  3. Piebaldism is an autosomal dominant trait (only requires the abnormal gene to pass from one parent). Vitiligo genetics are significantly more complicated, and many people have no known family members with the condition.
  4. Melanocytes are totally missing in the depigmented patches of piebaldism although they are present in vitiligo lesions that may not be working properly.
  5. Vitiligo often progresses. It spreads and comes and goes. Piebaldism is almost always consistent.
  6. Vitiligo is an autoimmune disorder although piebaldism is not.
  7. The two illnesses often have quite distinct comorbidities. Piebaldism is occasionally accompanied by Waardenburg syndrome and hearing loss, but vitiligo is more commonly connected with thyroid illness and other autoimmune disorders.

6 similarities between vitiligo and piebaldism

Six similarities between vitiligo and piebaldism include:

  1. In both situations, genetic factors are to blame.
  2. Both disorders are hereditary.
  3. The most visible signs of both these conditions are irregular patches of white skin, often known as leukoderma or leucism.
  4. In both conditions, skin and hair may lose their color.
  5. Patches are frequently symmetrical on both sides of the body.
  6. Both conditions are difficult to treat.

Piebaldism is sometimes mistaken for vitiligo. These are fundamentally unrelated illnesses that are not caused by developmental flaws or effects.

What is vitiligo?

Vitiligo is a skin condition that causes white patches to appear on the skin. Patches can form everywhere on the body, including the hair, eyes, and lips.

Common signs and symptoms of vitiligo

The predominant symptom is white spots on the skin. These patches can be of any size or location. Patches can be focused (limited to a few spots) or widespread (generalized).

Nonsegmental patterns: Most common

  • Appear on both sides of the body
  • Likely to be generalized and widespread
  • Involve hair
  • May be autoimmune with flare-ups

Segmental patterns

  • May appear on one side of the body
  • Develop quickly but then stop spreading
  • Usually not autoimmune

12 common sites of pigment loss

Twelve common sites of pigment loss include:

  1. Face
  2. Hands
  3. Arms
  4. The upper part of the chest and neck
  5. Groin and armpits
  6. Eyes
  7. Nostrils
  8. Mouth
  9. Navel
  10. Genitals
  11. Knuckles and elbows
  12. Area around moles


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6 causes of and risk factors for vitiligo

White spots are caused by melanocyte cell death. The exact cause of pigment loss is not known.

Possible causes of and risk factors for vitiligo include:

  1. The immune system may destroy the melanocytes (autoimmune)
  2. Defective nerve cells may make toxic substances that harm the melanocytes
  3. Maybe a genetic defect that makes the cells more vulnerable to damage
  4. More common in people between the ages of 10 and 30 years
  5. Family history of vitiligo
  6. Having preexisting autoimmune diseases

10 treatment options for vitiligo

There is no recognized treatment for vitiligo. The longer the patches remain, the more difficult it is to repigment the region.

  1. Psoralen plus UVA and narrow band UVB
  2. Excimer laser
  3. Skin creams
  4. Corticosteroid skin cream
  5. Tacrolimus or pimecrolimus skin creams
  6. Skin grafting 
  7. Depigmentation medication
  8. Cosmetics
  9. Sunscreen
  10. Psychiatric and behavioral counseling to manage stressors

The treatment of vitiligo usually aims to reduce the appearance of patches by:

  • Repigmentation
  • Slowing loss of color
  • Decreasing the difference between affected and unaffected skin

What is piebaldism?

Piebaldism is an uncommon genetic pigmentation condition characterized by patchy leukoderma (white skin) and white hair (poliosis) at birth.

8 common signs and symptoms of piebaldism

Eight common signs and symptoms of piebaldism may include:

  1. Hair growth above the brow is absent
  2. A white patch of hair around the hairline
  3. The skin beneath the forelock is not pigmented
  4. Hyperpigmentation can be seen around the boundary of depigmented regions
  5. Nonpigmented symmetrical areas on the torso, face, and extremities
  6. White eyelashes and brows
  7. Mid-forehead depigmented macule
  8. Depigmented patches of skin appear symmetrically on the body's sides

3 common causes of piebaldism

Three causes of piebaldism include:

  1. The lack of melanocytes (melanin-producing neural-crest-derived cells situated in the bottom layer of the skin's epidermis) in afflicted hair follicles and skin causes this disorder.
  2. Mutations in the KIT proto-oncogene, a type III transmembrane receptor for mast cell growth factor, cause this.
  3. This disorder is thought to be caused by 9 deletions, 14 point mutations, 3 insertions, and 2 nucleotide splice alterations in the KIT gene.

6 treatment options for piebaldism

Six treatment options for piebaldism include:

  1. Patients must be informed on the use of sunscreens, sun protection measures, and sun avoidance during peak UV exposure hours, as well as a self-skin inspection, to identify skin cancer.
  2. Dermabrasion of pigmented regions, followed by administration of melanocyte-enriched cell suspensions, may be done.
  3. Melanocyte transplantation is accomplished by shaving the top layer of skin (epidermis) and replacing it with a shave of skin from a pigmented spot.
  4. Full-thickness punch grafts or suction epidermal grafting is done.
  5. A mix of these approaches may be necessary, which can be supplemented with UV light therapy.
  6. Cosmetic camouflage methods can conceal hair and skin color changes.

Vitiligo and piebaldism are not the same, yet they share similarities with social stigma, lack of knowledge, discrimination, and consequent psychological suffering. Both need public education, awareness, and comprehension. Research that relates to one ailment frequently has implications for individuals with the other.

Medically Reviewed on 7/7/2022
Image Source: iStock image

A Case of piebaldism misdiagnosed as vitiligo over multiple generations: https://www.jaad.org/article/S0190-9622(14)00354-5/fulltext

Vitiligo and Piebaldism, What’s the difference: A Review Article: http://aditum.org/images/currentissue/1621406139Clinical_Research_and_Clinical_Case_Reports_Galley_Proof.pdf