Vitiligo is a long-term condition in which the cells that make pigment stop functioning in patches of skin, leaving areas that are lighter than the surrounding skin. It is understood as autoimmune in origin, it is not contagious, and its course varies a great deal between individuals.
What is actually happening in the skin?
Pigment is made by melanocytes, cells that sit along the base of the epidermis and pass melanin to the keratinocytes rising above them. Skin colour is the visible result of that arrangement working continuously.
In vitiligo those cells stop doing it in particular areas. The current understanding is autoimmune: the immune system acts against the melanocytes themselves, and where they are lost or rendered inactive, no pigment reaches the cells above.
The affected skin is otherwise structurally normal. Not thinner, not damaged, not scarred. That is why the borders can be so sharp, and why running a finger across one tells you nothing: the texture is unchanged.
Genetics contribute, and vitiligo occurs more often in people with a family history and alongside other autoimmune conditions. Some people describe patches appearing after a period of physical or emotional stress, or at a site of skin injury, the latter being a recognised pattern rather than coincidence.
The course is genuinely unpredictable. Patches may remain stable for years, may spread, and may in some cases repigment, and the same person can experience all three at different points in their life without anything in particular having changed to explain it. Nobody can tell from a photograph which of those will happen. Any account that suggests otherwise is overstating what is known.
How would a dermatologist describe it?
Depigmentation is the correct term, and it is distinguished from hypopigmentation, which means reduced rather than absent pigment. Vitiligo involves loss, which is why affected areas often appear starkly white rather than merely paler.
Non-segmental vitiligo is the more commonly described form, typically affecting both sides of the body in comparable distributions, often around the eyes and mouth, on the hands, and around joints. Segmental vitiligo affects one area or one side, tends to appear earlier in life, and is generally described as behaving differently over time.
Leukotrichia refers to hair turning white where the skin beneath is affected, and clinicians note it because it bears on what is likely.
The Koebner phenomenon appears here too: new patches developing at sites of injury to the skin. A Wood’s lamp, an ultraviolet light, is sometimes used in examination because it makes the extent of depigmentation clearer than ordinary light does, particularly in fairer skin.
Stable and active describe whether patches are currently changing. That distinction shapes much of the conversation that follows, and it is worth listening for.
What usually happens at a consultation?
The history covers when patches appeared, whether they have changed, whether anything preceded them, family history of vitiligo or of autoimmune conditions, and your general health. Questions about thyroid symptoms, tiredness and weight change are routine, given the recognised associations, and blood tests may be arranged for the same reason.
The examination looks over more of the skin than the areas you mention, including the scalp and hair, and may involve the lamp described above. Photographs are particularly valuable in vitiligo because change is gradual and comparing images over time is far more reliable than impressions.
Clinicians ask about effect on daily life, and in this condition that question carries real weight. Vitiligo causes no physical symptoms in most people, and its impact is social and psychological rather than bodily. A consultation that ignored that would be missing most of the condition.
What is worth asking?
Ask whether your vitiligo is currently considered stable or active. That assessment underlies most of what follows, and it is the piece of information people most often leave without.
Ask which tests are being arranged and why. Investigations for associated conditions are standard practice here, and understanding that they are routine rather than prompted by a specific worry saves an unnecessarily anxious wait.
Enquire about sun protection for affected areas specifically. Skin without pigment lacks a protection that the rest of your skin has, and this is a practical matter with a concrete answer.
Where the effect on how you feel is significant, raise it directly. Support exists and clinicians are used to discussing it, but it tends to be addressed only when someone says it aloud.
What this page does not do
It does not tell you whether pale patches on your skin are vitiligo; several conditions produce loss of colour and separating them requires an examination. No treatment, camouflage product or procedure is recommended here, and this page carries no commercial content of any kind.
Common questions
Is vitiligo contagious?
No. It cannot be passed to anyone by contact or by any other route. It arises from a person's own immune system acting against their pigment cells, and the persistent belief that it might be catching is a source of considerable and entirely unnecessary social difficulty.
Why does vitiligo often appear symmetrically?
The most commonly described form tends to affect both sides of the body in comparable places, which is one of the features clinicians look for. A form affecting one side or one area only is also recognised and behaves differently, which is why the pattern is assessed carefully.
Does vitiligo affect skin that is not visible?
It can appear anywhere pigment cells are found, including areas usually covered, and it may also affect hair, turning it white where the skin beneath is involved. A clinician will generally examine more than the patches you point out for this reason.
Is vitiligo linked to other conditions?
It is associated with other autoimmune conditions, particularly involving the thyroid, which is why a dermatologist asks questions and may arrange tests that appear to have nothing to do with skin. Those questions are routine rather than a sign of any particular concern.
Does the affected skin need particular attention in sunlight?
Areas without pigment lack the protection melanin provides, and sun protection is discussed at essentially every consultation about vitiligo for that reason. What that means practically for you is a conversation with your clinician rather than something to work out from a page.
Sources
- Vitiligo — conditions — NHS (United Kingdom) · accessed
- Patient information on skin conditions — British Association of Dermatologists (United Kingdom) · accessed
Last updated . How this page was written.