Dr. Sunil Prabhu
MBBS, MD, DNB Dermatologist, Venereologist and Aesthetic Physician, Aster RV Hospital JP Nagar Bengaluru

Vitiligo is a long-term condition where pale white patches develop on the skin. Melanin is the pigment present in the skin. The lack of this pigment causes vitiligo. Although vitiligo can affect any area of the skin the most common occurrences are prevalent on the face, neck and hands and skin creases. It can sometimes start in the lips, tips of fingers and genital areas also.

Vitiligo affects people of all skin types, but it may be more noticeable in people with brown or black skin. This disorder is not lethal or infectious and though considered an autoimmune disorder can be rarely associated with disorders in other endocrine organs like thyroid or adrenal glands. However, the appearance of vitiligo can cause stress and low self-esteem. It’s challenging to foresee how this disease will develop. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and finally involves most of the skin. In rare cases, the skin gets its colour back.

Signs and symptoms
The symptoms of vitiligo can appear at any phase of life. The signs include:
Loss of skin colour in patches, usually seen first on your face, hands, arms, legs, and feet
Early paling of your body hair, including hair on the lashes brows and face if the areas are involved.
Mostly it is asymptomatic and there are no symptoms like itching or pain.
Thyroid and Adrenal gland problems.

Detection of vitiligo
A dermatologist will be able to detect vitiligo post skin examination. The doctor will look for symptoms associated with other skin conditions, such as other hypopigmentary disorders like common eczemas or healing lesions of psoriasis etc in order to rule them out. The doctor will probably look at every area of the skin in order to determine which type of vitiligo you have based on where the patches appear. On dark skin, detection of patches is easy. But for lighter-skinned people, the doctor might use a tool called a Wood lamp (which emits ultraviolet light) as there is less distinction between the affected skin and unaffected skin. Skin with vitiligo will look different under this type of light. The tool can also be used to differentiate between loss of pigment and reduction in colour.

Lightened patches appearance and medical history of the patient is adequate for the diagnosis of vitiligo. However, doctors may recommend additional tests for further confirmation. For example, a skin biopsy will show whether melanocytes are present. Non-existence of melanocytes can confirm a vitiligo diagnosis.

The skin biopsy can also indicate whether the patient is dealing with a skin cancer called hypo pigmented cutaneous T-cell lymphoma. Doctors often recommend a blood test to check if the vitiligo is related to an underlying autoimmune disease, such as anaemia or type 1 diabetes. Because of the association with other autoimmune diseases and endocrinopathies, further testing may be necessary in patients with indicative signs or symptoms to rule out an underlying condition. Vitiligo may be associated with thyroid disease, diabetes mellitus, pernicious anaemia, Addison disease, and alopecia areata.

There is no cure as such for vitiligo but proper treatment can halt or slow the discolouring process and return some colour to the skin. The aim of the procedures is to create an even skin tone by either restoring colour (repigmentation) or eliminating the remaining colour (depigmentation). Camouflage therapy, repigmentation therapy, light therapy and surgery are some of the common treatments to cure vitiligo.