Vitiligo

What is vitiligo?

Vitiligo is a chronic skin condition where the skin and hair loses melanin (pigmentation) leaving white patches. Vitiligo can affect any area of skin, but it commonly happens on the face, neck, genitals, breasts, and hands and feet.

The patterns may be segmental, generalised or sometimes even universal (involving almost the whole body).

What causes vitiligo?

Vitiligo is an autoimmune condition. There may be a family history of vitiligo or other autoimmune conditions like hyperthyroidism. The body produces antibodies to attack melanocytes which are the cells that produce melanin. Vitiligo may be triggered by certain things, such as stress, sunburn or skin trauma, hormonal changes such as puberty and certain chemicals.

What is the treatment for vitiligo?

Sun protection: Vitiligo areas are more vulnerable to sunburn, so it is important to use a sunscreen with a high sun protection factor (SPF).

Topical medication: Topical steroid and calcineurin inhibitors (e.g. pimecrolimus, tacrolimus) are the first line treatment. New topical Janus kinase (JAK) inhibitors such as Opzelura® (ruxolitinib) are prescribed for persistent cases.

Phototherapy: Phototherapy with UVB or UVA may be tried if the response to topical treatment is not effective. These are available as a home portable light device for small areas or specialised full body light panels in a tertiary centre. Mulitple sessions are required. 

Oral JAK inhibitors: Currently these are considered off label medication for vitiligo. But undergoing research is promising.

Surgical grafting: For stable small areas of vitiligo, surgical treatment to transfer melanocytes from normal skin (the donor site) to the skin affected by vitiligo may be considered.