Vitiligo – Causes, Types and Management


Medical Registrar, Department of Telemedicine, Star Health and Allied Insurance


It also goes by the name piebald skin or leukoderma.

It is a chronic autoimmune skin disorder that hypo-pigments skin areas as it lightens them. This creates an imbalance in the patient’s skin colour throughout the body, causing areas of hypo- and hyper-pigmented patches. Certain skin cells that go by the name melanocytes produce a crucial chemical substance called melanin which is responsible for maintaining our natural skin colour. This melanin is destroyed or attacked by the person’s own immune system, which is why it is an autoimmune skin disorder.

Causes of Vitiligo

“Genetic susceptibility and environmental factors play a major role in causing Vitiligo.”

  • Defect in the gene TYR, which is responsible for melanocyte functioning.
  • Since the exact reason for Vitiligo is not yet proven by scientists – Let alone the above causes, anybody can get Vitiligo, and it can be diagnosed between the span of 10 to 30 years of age. Rarely presents in extremes of age groups.
  • 30% of Vitiligo patients have at least a second-degree relative being affected by this skin disorder. But, it is not always inherited in all cases.
  • Can be associated with other autoimmune diseases such as Hypothyroidism, Diabetes, Addison’s disease, Pernicious anaemia, Psoriasis, Systemic lupus erythematosus, Rheumatoid arthritis and Alopecia areata. Vitiligo can arise along with these conditions or can occur before.
  • Certain harsh environmental factors can aggravate the hypo-pigmented patches, such as sunlight, physical or psychological stress and chemical exposures.

Presentation of Vitiligo

  • Milky white patches occur over the extremities initially.
  • They are small and itchy hypo-pigmented macules at first, which eventually increase in size.
  • It can occur over the face, hands, legs, elbows and knees.
  • If it is present over hair-bearing areas such as the scalp, eyebrows or eyelids, the hair present there can also lose its colour and turn lighter. Especially on the scalp, the hair can grow prematurely grey.
  • It can arise around orifices such as the mouth, nostrils, umbilicus and genitalia. 

Types of Vitiligo

  •  Generalised appears on different parts of the body and is most common.
  • Focal is a rare manifestation; it occurs only in a single part of the body.
  •  Mucosal involves the oral and genital mucosas.
  • Universal is rare, and it affects more than 80% of the body’s skin pigmentation.
  •  Trichrome looks pretty much like a flag where there will be a patch of hypo-pigmentation followed by normal skin colour.
  •  Segmental is restricted to one side of the body area or a significant body part such as hands or face.

Management of Vitiligo

“Vitiligo cannot be prevented; only management is possible.”

  • Safe sun exposure by using sunscreen with SPF 50 along with UVA and UVB blocking filters can help to even the skin tone. Limiting sun exposure and using sun protective clothing is also crucial.
  • Make-up products to mask the small uneven patches can be helpful to camouflage.
  • Hair dyes for grey hairs.
  • De-pigmentation drugs such as monobenzone can be applied to the normal-tone skin to match the milky white patches for those who have universal Vitiligo.
  • Light therapies and surgeries can also be the last resort.
  • Always follow a dermatologist’s guidance for treatment with drugs and procedures.


Psychological effect

Being a cosmetic issue, Vitiligo can create low-self esteem issues and lead to depression eventually. Many celebrities have come out and spoken boldly about their initial struggles with Vitiligo, to name a few – Popstar Micheal Jackson, Canadian model Winnie Harlow and many more. Social stigma can arise if the public is not educated that Vitiligo is a non-communicable disease. Counsellors and Vitiligo socialising groups can help in overcoming mind discomforts pertaining to living with Vitiligo.

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