Vitiligo

Diagnosis

Diagnosing vitiligo begins with a detailed medical history and a skin examination. Your healthcare provider may use a special lamp to look at your skin more closely. The evaluation might also include:

• A skin biopsy to check for pigment-producing cells

• Blood tests to look for autoimmune conditions or vitamin deficiencies

These tests help rule out other causes of skin discoloration and confirm the diagnosis of vitiligo.

Treatment

Treatment for vitiligo depends on several factors, including your age, how much skin is affected, how quickly the condition is progressing, and how it impacts your daily life. The goal of treatment is to restore skin color or even out skin tone, though results vary and may take months to appear.

In some cases, self-tanning products or makeup may be recommended before starting medical treatments.

Medications

No medication can completely stop the loss of pigment, but some can help restore color when used alone or combined with light therapy.

• Corticosteroid creams may help bring color back, especially in the early stages. They can take several months to show results and may cause thinning or streaking of the skin.

• Corticosteroid pills or injections may be used for rapidly spreading cases.

• Calcineurin inhibitors such as tacrolimus (Protopic) or pimecrolimus (Elidel) can be helpful for small areas, especially on the face and neck.

• Ruxolitinib (Opzelura), a JAK inhibitor approved by the FDA, can help restore pigment in people aged 12 and older.

Therapies

• Light therapy (narrow-band UVB): This treatment can slow or stop vitiligo progression and may be used with medications. It usually requires two to three sessions per week for several months.

• Psoralen and light therapy (PUVA): Combines a plant-based drug called psoralen with UVA light exposure. It is effective but more difficult to administer and less commonly used today.

• Depigmentation: For widespread vitiligo, a depigmenting agent may be applied to lighten unaffected skin, blending it with discolored areas. This is a permanent change and is used only when other options fail.

Surgery

Surgery may be considered if medications and light therapies are unsuccessful and the condition is stable. Techniques include:

• Skin grafting: Small sections of pigmented skin are transplanted to discolored areas.

• Blister grafting: The tops of blisters from healthy skin are transferred to affected areas.

• Cellular suspension transplant: Pigment cells are extracted and applied to depigmented skin.

All procedures carry risks such as infection, scarring, or uneven skin tone.

Potential future treatments

Researchers are studying new therapies that may stimulate pigment cells or help control their growth, including:

• Afamelanotide, a drug implanted under the skin to encourage melanocyte growth

• Prostaglandin E2 gel, which may help restore color in localized cases

Self care

Lifestyle and skincare habits play an important role in managing vitiligo.

• Protect your skin from the sun using SPF 30 or higher sunscreen and wear protective clothing.

• Avoid tanning beds and sunlamps.

• Use makeup or self-tanning products to even skin tone.

• Avoid tattoos or skin injuries, as they may trigger new patches.

Alternative medicine

Some small studies suggest that Ginkgo biloba, alpha-lipoic acid, folic acid, vitamin C, and vitamin B-12 combined with phototherapy may help restore skin color. Always talk to your healthcare provider before trying supplements or herbal remedies.

Coping and support

Vitiligo can affect confidence and emotional health. These approaches may help you cope:

• Work with a dermatologist experienced in treating vitiligo

• Learn about your condition and treatment options

• Talk openly with your healthcare provider if you feel depressed

• Join support groups or connect with others living with vitiligo

• Seek encouragement from family and friends

Preparing for your appointment

You may start with your primary care provider, who can refer you to a dermatologist. To prepare:

• Review your family medical history for autoimmune diseases or skin disorders

• List any recent stress, skin rashes, or sunburns

• Note all medications, vitamins, and supplements you take

• Prepare questions to ask, such as:

  • What is the most likely cause of my symptoms?

  • What treatments do you recommend?

  • Are there any side effects or lifestyle changes I should expect?

  • Can you recommend ways to conceal discolored patches?

What to expect from your doctor

Your healthcare provider may ask:

• When did you first notice light patches on your skin?

• Do you have any symptoms like itching or sensitivity to sunlight?

• Does anyone in your family have vitiligo or autoimmune diseases?

• Do you work with chemicals or have frequent sun exposure?

• How is this condition affecting your quality of life?

What you can do in the meantime

While waiting for your appointment, limit sun exposure, apply sunscreen daily, and use makeup or self-tanning products if desired. These steps can help protect your skin and improve your comfort and confidence.