Ask The Expert: Vitiligo (Part 1)

What is vitiligo?
Vitiligo is an auto-immune disease and skin disorder which causes depigmentation. This means there is a complete absence of melanocytes in affected skin. The autoimmune cells cause destruction of the melanocytes, turning the affected skin and sometimes even hair white.

Where does vitiligo occur?
Vitiligo usually presents with depigmented patches on the skin. The first lesions are usually seen on the face, on the hands and on the feet and are quite visible. Vitiligo can also be seen on lips, the genitals and the hair.

Who gets vitiligo?
Vitiligo can affect anyone of any age and from any place in the world. In the majority of patients, it will occur for the first time in children or adolescents/young adults.

How do you know if someone has vitiligo?
The diagnosis of vitiligo is usually a clinical one, rarely a biopsy may be needed to differentiate it from other causes of hypo- or depigmentation. It is important to also look for other autoimmune conditions that can be associated with vitiligo. For example, about 15% of patients with vitiligo will have autoimmune thyroid disease.

What is the difference between hypopigmentation and depigmentation?

While textbooks will often discuss melanopenia versus melanocytopenic conditions, to make this simple, we can define hypopigmentation as being a state in which there is a decreased number of melanocytes and or melanin. Depigmentation is a state in which the skin has a complete absence of melanocytes. Vitiligo is a depigmenting condition.

Differentiating between hypo- and depigmentation is important because it helps us work out what condition the patient may have. Figuring this out is relatively easy in those with skin of colour but for those with lighter skin, it can be difficult. In such cases the use of a Woods lamp which is a light that emits 365nm can be used because if there is an absence of pigment, the area shines bright white.

What sort of skin conditions cause hypopigmentation?
Hypopigmentation can result from many skin conditions ranging from fungal infections and eczema, through to post-inflammatory hypopigmentation. Skin conditions like sarcoidosis and even use of topical steroids or the incorrect use of a particular laser can cause hypopigmentation.

What types of vitiligo are there?
There are two main types of vitiligo- segmental vitiligo, and general vitiligo. Segmental vitiligo is far less common; about 2% of patients have segmental vitiligo in which a small patch of skin only is involved. Then there is general vitiligo, in which spots can develop on different parts of the body over time. This is easier to manage in terms of its medical therapy, but it needs to be started early.

How do you make the diagnosis of vitiligo?
Usually, the diagnosis is clinical. This means we can look carefully at the skin and decide if vitiligo is likely. Occasionally a skin biopsy is needed.

Sometimes the patients (or parents of the patient) have seen multiple practitioners and are provided with different diagnoses from fungal infection through to yeast infection through to eczema. So, sometimes a biopsy provides reassurance for them that vitiligo is in fact the diagnosis.

Keep your eyes peeled for PART TWO of the ask the expert series on vitiligo.

For more scientifically factual information on vitiligo, check out our prior blogs and website posts!

The information contained in this blog post is intended as a guide only and should not substitute seeking medical attention. Please see your healthcare provider for more information on suitability of products, treatments or procedures.