Vitiligo: Causes, Symptoms, and Treatment Options

Vitiligo is an autoimmune disorder where melanocytes are destroyed, causing depigmented white patches on skin and mucosa.

Key Features

• Distribution: Generalized (symmetrical), segmental (dermatomal), focal, acrofacial, universal.
• Onset: Often before age 30; 50% childhood.
• Associations: Thyroid autoimmunity (Hashimoto's, Graves'), alopecia areata, type 1 diabetes, pernicious anemia.
• Koebner phenomenon: New lesions at trauma sites.

Diagnosis

• Clinical: Chalk-white macules, sharp margins, Wood's lamp enhancement.
• Biopsy rarely needed; shows absent melanocytes.
• Screen for autoimmune comorbidities (TSH, TPO Ab, ANA, CBC, glucose).

Treatment (Goal: Stabilize + Repigment)

• Topical: Corticosteroids (mid-potency), calcineurin inhibitors (tacrolimus, pimecrolimus) — face/folds.
• Phototherapy: Narrowband UVB (NB-UVB) 2–3×/week — gold standard for widespread disease. Excimer laser for localized.
• Systemic: Low-dose oral steroids (minipulse) for rapid stabilization; JAK inhibitors (ruxolitinib cream FDA-approved 2022; oral in trials).
• Surgical (stable disease >1 yr): Suction blister grafting, melanocyte-keratinocyte transplant (MKTP).
• Camouflage: Dermablend, Microskin, tattooing (micropigmentation).

Psychosocial Support

Vitiligo significantly impacts quality of life. Counseling, support groups (Vitiligo Support International), and advocacy reduce stigma.

Early treatment yields better repigmentation. See a dermatologist experienced in vitiligo.