Vitiligo: Diagnosis and treatment
If you have light spots and patches on your skin, getting an accurate diagnosis is important. White spots and patches develop for many reasons.
You might have vitiligo. You could also have another condition like tinea versicolor. The white spots may also be caused by a skin injury. A board-certified dermatologist can give you an accurate diagnosis.
How do dermatologists diagnose vitiligo?
A board-certified dermatologist diagnoses vitiligo by reviewing your medical history and examining your skin.
To get a good look at your skin, your dermatologist may use a Wood’s lamp. This specialized lamp allows a dermatologist to clearly see areas of vitiligo.
To give patients an accurate diagnosis, dermatologists examine a patient’s skin under different lighting
In everyday lighting (A), the vitiligo on this patient’s skin is barely visible. When examined under different types of Wood’s lamps (B and C), the patches are easier to see.
If your dermatologist finds that you have vitiligo, blood tests may be recommended. Vitiligo is an autoimmune disease. This means that your immune system is attacking healthy cells in your body that give your skin its color.
People who have vitiligo have a higher risk of developing some other autoimmune diseases like thyroid disease. Blood tests can find autoimmune diseases like thyroid disease.
After giving you the diagnosis, your dermatologist will also ask whether you want to treat the vitiligo. Some people choose not to. Model Winnie Harlow, who has vitiligo, lets the world see her skin as it is.
Rather than get medical treatment, some people prefer to cover up the light patches with makeup, self-tanner, or skin dye.
If you want to treat vitiligo, dermatologists have treatments that can restore lost skin color.
How do dermatologists treat vitiligo?
When treating vitiligo, board-certified dermatologists create a treatment plan with these goals in mind:
Restore lost skin color
Stop the patches and spots from getting bigger and new spots from appearing
There is no one best treatment for vitiligo. Before creating a treatment plan, a dermatologist thinks about what is best for each patient. To do this, your dermatologist considers your age, overall health, and effects the disease has on your life. The type of vitiligo, where it appears on the body, and how it’s progressing also play important roles.
Before and after camouflage makeup
Some patients prefer to cover up vitiligo with camouflage makeup rather than treat it. Camouflage makeup can also hide vitiligo until treatment works.
If you decide to treat vitiligo, it’s important to know the following:
Treatment works slowly. When treatment works, your natural skin color returns a little at a time.
Vitiligo can be stubborn. Your dermatologist will begin with the gentlest treatment that’s suitable for you. To get desirable results, your dermatologist may add another treatment or change your treatment.
Treatment cannot cure vitiligo. While researchers are looking for a cure, treatment cannot currently cure this disease. Treatment can help restore lost skin color, but results may fade over time. Many patients return for maintenance treatment to keep their results.
Here are the treatments that dermatologists consider for their patients who have vitiligo.
Medication you apply to your skin
Purpose: Restore lost skin color
Several prescription medications that you apply to your skin are used to treat vitiligo. You apply these at home.
One of these medications is a prescription corticosteroid. This medication works best for people who recently developed vitiligo.
Due to possible side effects, dermatologists prescribe a corticosteroid for a short period of time. When used short-term, this medication is often effective for both children and adults.
Tacrolimus ointment or pimecrolimus cream is another option for children and adults. One advantage of these medications is that they can be used for a longer time than corticosteroids. These work best to treat skin on the head or neck.
Another medication that may restore lost pigment is calcipotriene. While not effective when used alone, it can be effective when used with a corticosteroid. Applying both of these medications as directed can increase the amount of re-pigmentation you see and shorten the time it takes to get results. Dermatologists prescribe calcipotriene for children and adults.
Light therapy
Purpose: Restore lost skin color
Light therapy exposes your skin to a type of ultraviolet (UV) light that can restore your natural skin color. If a large area of your body needs treatment, your dermatologist may prescribe a treatment called phototherapy.
During phototherapy, you expose your skin to UV light for a specific amount of time. A dermatologist calculates the right amount of time for each patient. The UV light comes from a light box, which you stand in.
If you need treatment targeted to a certain part of your body, your dermatologist may prescribe laser therapy. A laser can target a small section of skin, so there’s less effect on skin that doesn’t need treatment.
Light therapy is most effective at restoring color to the face and neck. The lips, tips of the fingers, and toes are least responsive to treatment with light therapy.
If light therapy is an option for you, you will need a number of treatments.
Light therapy works slowly. To return color to your skin more quickly, your dermatologist may prescribe light therapy along with treatment that you apply to your skin.
Medication you take
Purpose: Slow down the development of new spots and patches, restore skin color
Vitiligo tends to spread slowly. Occasionally, it spreads quickly. If you’re seeing new patches and spots on your skin frequently, your dermatologist may prescribe prednisone. This is a powerful medication that can help slow down the disease. It comes in pill form. You take prednisone for one to two weeks.
Surgery
Purpose: Restore skin color
If other treatments fail to restore skin color, surgery may be an option. Two types of surgery are used to treat vitiligo:
Skin graft: Your dermatologic surgeon removes some healthy, pigmented skin and transplants it to one or more areas with vitiligo.
Cell transplant: During this type of surgery, your dermatologic surgeon removes some healthy, pigmented skin. Instead of grafting the skin into an area with vitiligo, the surgeon takes cells from the skin that was removed. These cells are then placed into skin with vitiligo. Most re-pigmentation from these cells happens within six months of surgery. However, dermatologists have seen patients continue to re-pigment for up to 12 months. Surgery may be an option for people of all skin tones and for people who have different types of vitiligo. However, it’s not an option for everyone.
Surgery usually isn’t recommended for people who have active vitiligo, which means that over the last 12 months new spots have developed or existing spots have grown.
Surgery also may not be an option for people who developed raised scars. Surgery could cause scarring.
Before and after cell transplant surgery
Four months after cell transplant surgery, this man’s vitiligo is barely noticeable.
Makeup, self-tanner, and skin dye
Purpose: Even out your skin tone right away
Getting results from treatment takes time. To help you even out your skin tone until you get results, your dermatologist may recommend using one of these products.
Camouflage makeup
Self-tanner
Skin dyes
These are also an option for patients who decide not to treat vitiligo.
If you’re interested in trying these products, ask your dermatologist for a recommendation. Your dermatologist can recommend a product that will match your skin tone and stay on all day long.
As a rule, self-tanning products are waterproof and give you coverage for 3 to 5 days. Camouflage makeup is lightweight and waterproof, but you need to apply it every day.
To get natural-looking results from these products, you’ll need to learn how to apply them and practice.
Diet and supplements for vitiligo
Purpose: To provide your body with missing nutrients
You may have heard that certain vitamins, minerals, amino acids, or enzymes can restore your natural skin color. Researchers are studying the effects that these may have on vitiligo. More research is needed to know whether any diet or supplements can effectively treat vitiligo.
Depigmentation
Purpose: Remove the remaining color from your skin
Depigmentation is rarely used. It’s only an option for patients who have lost most of their natural skin color and don’t want to continue with treatment meant to restore color to their skin.
Depigmentation removes the remaining natural color, creating an even skin tone. To remove the remaining color from their skin, a patient applies a cream to the areas of skin that still have pigment. The cream gradually removes the remaining color. It can take one to four years to get rid of the remaining pigment.
If you’re considering this approach, talk with a board-certified dermatologist about the pros and cons of depigmentation. This treatment is considered permanent.
How do dermatologists treat vitiligo in children?
Vitiligo can begin at any early age. This makes treatment options for children important.
Many treatments described above are used to treat children. Before creating a treatment plan for your child, your dermatologist thinks about the child’s age, how the vitiligo is spreading, other medical conditions your child has, and many other considerations.
Dermatologists are studying new vitiligo treatments
Vitiligo can be stubborn. To find better treatments, dermatologists run clinical trials. Results from recent clinical trials are promising.
A type of medication called a Janus kinase inhibitor (JAK inhibitor for short) may be an effective treatment for vitiligo. JAK inhibitors calm the patient’s overactive immune system, which can stop the body from destroying melanocytes, the cells that give skin, hair, and other parts of your body their color. When this stops, the skin can re-pigment.
Some JAK inhibitors you apply to the skin with vitiligo. Others comes in pill form.
Dermatologists are also studying a medication that when implanted into the skin stimulates the skin cells to make pigment.
Some of the medications that are being studied as a possible treatment for vitiligo are FDA-approved to treat other diseases. For example, one JAK inhibitor that dermatologists are studying as a possible treatment for vitiligo is called ruxolitinib cream. The U.S. Food and Drug Administration (FDA) has approved this medication to treat atopic dermatitis in patients 12 years of age and older who have a healthy immune system.
Maintenance therapy often required to keep treatment results
While treatment can restore lost skin color, sometimes, the results are temporary. Within a year of ending treatment, it’s estimated that about 40% of patients see some color loss.
Maintenance therapy helps to prevent this color loss. To maintain results, dermatologists often prescribe a medication that you apply to your skin a few times per week.
When medication is used along with self-care, many patients keep the color that treatment added to their skin.
To see the self-care that dermatologists recommend for their patients who have vitiligo, go to Vitiligo: Self-care.
Related AAD resources
Images
Image 1: Used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2020 Oct;83(4):e283-4.
Image 2: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2014;71:935-40.)
Image 3: Used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2012 May;66(5):785-93.
References
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Bae JM, Lee RW. “365-nm narrowband Wood's lamp for vitiligo and hypopigmentation disorders.” J Am Acad Dermatol. 2020 Oct;83(4):e283-4.
Cavalié M, Ezzedine K, et al. “Maintenance therapy of adult vitiligo with 0.1% tacrolimus ointment: a randomized, double blind, placebo-controlled study.” J Invest Dermatol. 2015 Apr;135(4):970-4.
Felsten LM, Alikhan A, et al. “Vitiligo: A comprehensive overview Part II: Treatment options and approach to treatment.” J Am Acad Dermatol. 2011 Sep;65(3):493-514.
Grimes PE. “Vitiligo.” In: Taylor and Kelly’s Dermatology for Skin of Color. (second edition). McGraw Hill, USA, 2016:341-8.
Nahhas AF, Braunberger TL, et al. “Update on the Management of Vitiligo.” Skin Therapy Lett. 2019 May;24(3):1-6.
Rodrigues M, Ezzedine K, et al. “Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo.” J Am Acad Dermatol. 2017 Jul;77(1):1-13.
Rosmarin D, et al. “Efficacy and safety of ruxolitinib cream monotherapy for the treatment of vitiligo: Results from two 52-week phase III studies.” Presented at: American Academy of Dermatology Annual Meeting 2022; March 25-29, Boston, MA.
Silpa-Archa N, Griffith JL, et al. “Long-term follow-up of patients undergoing autologous noncultured melanocyte-keratinocyte transplantation for vitiligo and other leukodermas.” J Am Acad Dermatol. 2017 Aug;77(2):318-27.
Yamaguchi Y, et al. “Ritlecitinib (PF-06651600), an oral JAK3/TEC inhibitor, stabilizes active lesions and promotes re-pigmentation of stable lesions in patients with active non-segmental vitiligo: Results from a phase IIb, randomized, placebo-controlled, dose-ranging study.” Presented at: American Academy of Dermatology Annual Meeting 2022; March 25-29, Boston, MA.
Written by:
Paula Ludmann, MS
Reviewed by:
Kesha Buster MD, FAAD
Sandy Marchese Johnson, MD, FAAD
Bassel Hamdy Mahmoud, MD, PhD, FAAD
Last updated: 6/29/22