The loss of pigment from hairs in the eyelash area accentuates the color loss of vitiligo. In fair skin patients, vitiligo can be subtle.  The total loss of pigment cells make these patients high risk for sunburn within the affected areas.   This image displays areas of complete absence of skin pigment typical of vitiligo. This image displays one spot of lightened pigment due to vitiligo. In people with darker skin, the areas of pigment loss in vitiligo are quite distinct. This image displays a patient with vitiligo that affects his beard area and the area around his lips. This image displays vitiligo on the backs of feet. This image displays an almost total pigment loss in a patient with vitiligo. Vitiligo is an auto-immune condition that results in flat areas of pigment loss.  Fingers are a common location. The pigment loss in this woman with vitiligo forms an irregular patch.
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Vitiligo  Information for adults

Picture of Vitiligo: The loss of pigment from hairs in the eyelash area accentuates the color loss of vitiligo. Divider line
The loss of pigment from hairs in the eyelash area accentuates the color loss of vitiligo.
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Overview
Vitiligo is a disease where the immune system turns against itself (autoimmune disease) where immune cells of the body attack the color-producing (pigment-producing) cells to cause white patches on the skin, which may contain hairs that are white in color. It may be seen with other autoimmune diseases, such as thyroid disease, alopecia areata, diabetes mellitus, Addison disease, and myasthenia gravis. The way that vitiligo progresses varies greatly; it may remain in the area where it started (localized) or it may become more widespread.
Who's At Risk
Vitiligo may occur at all ages but usually begins between the ages of 2 and 40. All races may be affected. Despite a common belief, vitiligo is not seen more often in blacks; this may seem to be true only because the condition causes a more obvious cosmetic problem for darker-skinned individuals.
Signs and Symptoms
Vitiligo most commonly affects areas of injury (trauma), particularly on the face, upper chest, hands, armpit, and groin. It may be widespread, affecting both sides of the body (generalized); it may affect only one side of the body (segmental); or it may affect only one localized area (focal).

Sharply defined white patches are seen. If the affected area contains hair, the hair may turn white.

Sometimes halo nevi may be seen, in which a mole is surrounded by a circular white patch, resembling a halo.
Self-Care Guidelines
To protect your skin from sunburning, particularly in the affected areas:
  • Avoid exposure to midday sun (10 AM to 3 PM).
  • Wear SPF 45 sunscreen.
  • Wear protective clothing and hats.
  • Apply Dermablend™ or Covermark® cosmetic cover-up makeup to hide white (depigmented) patches.
When to Seek Medical Care
It is not necessary to treat vitiligo, but seek medical evaluation if it becomes bothersome.
Treatments Your Physician May Prescribe
Your doctor may try any of the following:
  • Topical steroid creams or ointments to help restore skin color. Use these with caution because of the risk of tissue damage (atrophy) with prolonged use, particularly on the face and skin fold areas.
  • Topical non-steroid medications, such as tacrolimus and pimecrolimus, which deactivate immune cells, may be of benefit. These medications, however, can increase your risk of developing cancer (malignancy).
  • Ultraviolet (UV) light therapy for lesions that do not affect the joints.
  • For very large or widespread lesions in dark-skinned patients, topical chemicals remove color (depigment) the normal skin.
  • Superficial skin grafts, especially in hard-to-treat (recalcitrant) locations, such as over joints.

References

Bolognia, Jean L., ed. Dermatology, pp.947-955. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.839-847. New York: McGraw-Hill, 2003.
Last Updated: 22 Dec 2008