Vitiligo: symptoms, causes, treatment and living with it

The NHS says treatment for vitiligo is based on changing the appearance of the skin by restoring its colour, but that for some people it is not permanent and it cannot always control the spread of the condition. You may also choose not to have treatment; the BAD says whatever you decide, it is important to protect your skin from the sun.

A GP may recommend sun safety, a referral for camouflage creams or a topical steroid. The NHS says a topical steroid may be prescribed to adults if they have non-segmental vitiligo on less than 10% of the body, want further treatment, are not pregnant and accept the risk of side effects, and that a follow-up is usually arranged after 1 month and again after another month or two. Side effects can include skin thinning and stretch marks.

If those do not work, a dermatologist may recommend topical calcineurin inhibitors such as tacrolimus or pimecrolimus, which the NHS says do not cause thinning of the skin, phototherapy, ruxolitinib cream for facial vitiligo in people aged 12 and over, skin grafts for stable patches, or depigmentation in adults with vitiligo on more than 50% of the body.

Non-segmental vitiligo is thought to be an autoimmune condition, in which the immune system mistakenly destroys melanocytes. Segmental vitiligo is thought to relate to chemicals released from nerve endings in the skin that are toxic to melanocytes. The NHS lists risk factors for non-segmental vitiligo, including a family history of vitiligo or other autoimmune disease, another autoimmune condition, and particular gene changes.

Possible triggers include stressful events such as childbirth, skin damage such as severe sunburn or cuts (the Koebner response), hormonal changes such as puberty, liver or kidney problems and exposure to certain chemicals. The BAD notes there is no proven link between vitiligo and diet or smoking, and that vitiligo can run in families without meaning that children will definitely develop it.

Because of the autoimmune link, the NHS says a GP may ask about symptoms of other conditions, such as tiredness suggesting Addison's disease or thirst and frequent urination suggesting diabetes, and may order a thyroid blood test.

Vitiligo happens when there are too few working melanocytes, the skin cells that produce melanin and give skin its colour. The result is pale, pink or white patches with defined edges. The British Association of Dermatologists says the skin feels normal to the touch, hair inside patches may turn white, and the condition can also affect lips and nails.

It is common and affects people of every skin tone, though patches are more noticeable on brown or black skin. The NHS and the BAD agree on two points that matter for reassurance: vitiligo is not caused by infection, and it cannot be passed on to someone else.

The NHS says vitiligo often starts as a pale patch of skin that gradually turns completely white. The edges may be smooth or irregular and are sometimes red and inflamed, or have brownish discolouration. The lack of melanin can turn the hair in the affected area white or grey. It does not cause discomfort such as dryness, but the patches may occasionally be itchy.

The NHS lists the mouth and eyes, fingers and wrists, armpits, groin, genitals and inside the mouth as commonly affected, and says it can affect any area of skin. BAD says some people feel itching before a new patch appears, and that when colour comes back it often starts around hair roots, giving a speckled look. The NHS says there is no way of predicting how much skin will be affected.

The NHS describes two main types. Non-segmental vitiligo, also called generalised or bilateral, usually produces symmetrical patches on both sides of the body, for example on the backs of the hands, arms, knees, elbows, feet and skin around body openings such as the eyes. It is the most common form, affecting around 9 in 10 people with vitiligo. Segmental vitiligo affects one area only. It is less common overall but more common in children, usually starting earlier and affecting around 3 in 10 children with vitiligo. In rare cases the whole body can be affected, known as universal vitiligo.

The BAD says it can be important to know which type you have, because it helps decide treatment, and non-segmental vitiligo is the type most likely to spread.

The NHS says vitiligo is not caused by an infection and you cannot catch it from someone else who has it. BAD says it is not contagious and cannot be passed on to another person, and that there is no proven link between vitiligo and diet or smoking.

BAD says vitiligo can run in families, but having vitiligo does not mean your children will definitely get it. The NHS lists a family history of vitiligo or of other autoimmune conditions among the risk factors for non-segmental vitiligo.

Vitiligo is usually diagnosed by how it looks. A GP will examine the skin and ask about family history, past injury, sun response, and whether patches are spreading. A Wood's lamp, an ultraviolet lamp used in a dark room, makes patches easier to see and helps tell vitiligo from other causes of pale skin such as pityriasis versicolor, which is caused by a fungal infection.

The BAD says no specific blood test is needed to make the diagnosis, although tests for vitamin D, thyroid disease or other autoimmune conditions may be requested where relevant. Photographs may be taken to track change over time, and referral to a dermatologist is common when patches are small or resemble other conditions.

Patches contain no melanin, which acts as the skin's natural sunblock, so they burn more easily. Sun protection matters whether or not you choose treatment. The NHS adds that vitiligo may be associated with eye inflammation, including uveitis, and a partial loss of hearing, though these are not universal.

Confidence and mood can suffer, especially when visible areas are affected. The BAD says some people are untroubled while others experience anxiety and distress, and suggests speaking to your healthcare professional, who may recommend talking therapy, which you can also self-refer for through NHS Talking Therapies. The Vitiligo Society offers support, and Changing Faces advises on camouflage.

The NHS says that if your skin is not exposed to the sun there is an increased risk of vitamin D deficiency and that you should consider a daily supplement containing 10 micrograms of vitamin D. BAD suggests people who stay out of the sun might check their vitamin D levels and ask their GP for advice.

A GP can diagnose vitiligo by examining the affected skin. See a GP if you notice white patches on your skin, if existing patches are spreading, or if the condition is affecting your confidence or mood. The NHS says a GP may refer you to a dermatologist if they are unsure of the diagnosis, you are pregnant and need treatment, more than 10% of your body is affected, your face is affected and you want further treatment, or you are distressed about the condition.

The NHS says vitiligo may also be associated with eye problems such as inflammation of the iris or uveitis, and partial hearing loss. Tell your GP about any new eye symptoms or hearing changes.

Most people begin with a GP, who can diagnose vitiligo and begin treatment with sun protection and topical therapy. Dermatology referral is used for an uncertain diagnosis, spreading disease or access to phototherapy. BAD says newer treatments may only be available in a few specialist NHS centres.

Some people choose to see a private dermatologist for assessment or treatment options. Phototherapy needs frequent visits for many months, so ask about the practical schedule, the length of the whole course and what happens if colour does not return. The NHS says excimer laser and cell transplant treatments are not available on the NHS.