The pigment in our skin can change for many reasons. For example, when unprotected skin is exposed to UV rays, the skin produces more melanin as a protective mechanism against further damage, creating what we know as a temporary “tan.” Certain medications and hormonal changes can also affect melanin production and deepen the pigment of the skin. What about white patches on skin? While there are several reasons why white patches on the skin occur, a common one is vitiligo.
“Vitiligo is a non-contagious, chronic auto-immune disease that produces white patches on the skin when melanocytes are attacked and destroyed by your immune system,” says Dr. Joel Schlessinger, board-certified dermatologist, Mohs surgeon and cosmetic surgeon. “While there is no cure for vitiligo, we do have methods of treatment that can help manage the skin condition.”
To help you better understand vitiligo, we’ll discuss:
- Skin conditions that cause white patches on the skin
- The causes and risk factors of vitiligo
- Vitiligo prevention and treatment options
Skin conditions that cause white patches on the skin
White patches, or depigmentation of the skin, can occur for a multitude of reasons. Dr. Daniel Schlessinger, board-certified dermatologist as well as Mohs surgeon and cosmetic surgeon explains, “When skin loses pigment and turns lighter than normal, it’s essential to consult with a board-certified dermatologist to pinpoint the cause. While there are numerous causes, some common causes of light patches of skin are a fungal infection called tinea versicolor, prior inflammation causing light skin, or from vitiligo, which affects people of all skin tones, genders and ages.”
Vitiligo, which is diagnosed in about 2% of the world’s population, appears as milky-white patches on the skin and while they typically occur on the face, hands, feet and arms, they can present anywhere on the body. Nonsegmental vitiligo is the most common type where white patches appear symmetrically on the body, for example, if they appear on the left side of the body, they most likely appear on the right side as well. Segmental vitiligo is less common and will only affect one area or one side of the body.
Vitiligo can also cause hair to turn white in some areas and can affect the mucous membranes inside the mouth and nose, as well as the inner ears and eyes. Dermatologists use a special black light called a Wood’s lamp to inspect any white spots and help clinically diagnose vitiligo. In some cases, blood tests or biopsies may be required for diagnosis or to rule out other conditions.
The causes and risk factors of vitiligo
While research is ongoing, vitiligo is thought to be a multifactorial skin condition with contributions from multiple genetic risk factors and environmental factors contributing to its onset. Additionally, about 15-25% of people with vitiligo are also affected by at least one other auto-immune disease, including alopecia areata, hypothyroidism, Type 1 diabetes and others.
While more research is needed, vitiligo may be triggered by sun exposure, elevated stress levels and exposure to certain chemicals. Interestingly, injuries to the skin like cuts, rubbing, scratching, or very severe sunburns can also trigger vitiligo in genetically predisposed people, something known as Koebner’s phenomenon.
Vitiligo prevention and treatment options
No treatment will prevent or cure vitiligo, but there are options for anyone who wants to manage or keep it under control as best they can. Dr. Schlessinger says, “For some patients not experiencing any symptoms that cause discomfort, treatment for vitiligo may not be necessary. However, certain treatment options can be helpful for those who simply don’t like the cosmetic appearance of these changes in their skin pigment. We were proud to be a part of trials on JAK inhibitors that have been proven to significantly improve vitiligo across a wide population of patients. They do have side-effects and are quite costly, so they are not for everyone, though.”
As with most skin conditions, practicing proper sun safety, like wearing a broad-spectrum sunscreen with at least SPF 30 every day of the year, is key to keeping vitiligo from flaring further. Seek shade during peak hours and wear protective clothing and a hat whenever you can. Additionally, never try to “tan” your skin in hopes of regaining pigment, instead, you can try camouflage makeup to even your skin tone like Dermablend Professional Cover Crème SPF 30, which comes in a wide range of shades and includes 3% titanium dioxide for supplemental sun protection.
Heliocare Ultra Antioxidant Supplements, which can help enhance the effects of sunscreen, can also be very effective for helping patients with vitiligo.
Topical corticosteroids like FixMySkin 1% Hydrocortisone Healing Balm are often the first course of treatment for vitiligo and help control the progression of white patches on skin by addressing inflammation and calming the body’s immune system response. However, you should always undergo a corticosteroid regimen under the care of a board-certified dermatologist. If topical corticosteroids have proven ineffective against vitiligo, a topical calcineurin inhibitor may be prescribed, which is also suitable for vitiligo occurring on sensitive areas like the eyelids or lips.
Certain Janus Kinase Inhibitors (JAK) are a promising treatment for the management of vitiligo, as they have been shown to help skin on the face and body to regain some pigment. Opzelura (ruxolitinib) cream, which was originally prescribed as an eczema treatment, is the first FDA-approved cream to treat nonsegmental vitiligo, and works by blocking signaling pathways in the body that are responsible for the immune response associated with vitiligo.
Narrowband-ultraviolet B phototherapy has also been shown to be a somewhat effective treatment option for enduring re-pigmentation of skin. One systematic review of research on phototherapy for vitiligo showed the best results for re-pigmentation occurring on the face and neck. “We have this modality in our clinic, but with JAK inhibitors available now, we won’t generally be using this unless there is a very small area of vitiligo present,” says Dr. Schlessinger.
“ For patients who are experiencing vitiligo and loss of pigment over a majority of your body, there is an option for complete depigmentation of the skin, but it is only for the worst of cases and generally is NOT something I recommend,” says, Dr. Schlessinger. Monobenzone is an FDA-approved medication that removes all pigment from the skin, but this is an option that should be thoroughly discussed with a board-certified dermatologist for consideration as it is permanent and irreversible.
Living with vitiligo can be difficult for many patients as they manage symptoms and cope with the self-esteem effects of vitiligo. If you are noticing white patches on the skin, schedule an appointment with Dr. Joel Schlessinger by visiting our appointment page and booking conveniently online or you can visit our clinical trials page to see if you’re a candidate for upcoming studies on the latest medications for treating vitiligo.