Vitiligo

Vitiligo is a chronic autoimmune condition in which the immune system erroneously destroys melanocytes — the cells responsible for skin, hair, and eye pigmentation — resulting in depigmented (white) patches on the skin and sometimes hair and mucous membranes. It affects approximately 0.5–2% of the global population regardless of race or skin tone. Two broad types exist: non-segmental vitiligo (bilateral, symmetrical, progressive — the most common form) and segmental vitiligo (unilateral, limited distribution, tends to stabilize earlier). Vitiligo is strongly associated with other autoimmune conditions including thyroid disease (Hashimoto's, Grave's), type 1 diabetes, rheumatoid arthritis, and alopecia areata. While not medically dangerous, vitiligo carries substantial psychosocial and quality-of-life burden — amplified significantly on darker skin tones where contrast is more visible.

• Flat, depigmented (white or lighter-than-baseline) patches on skin
• Loss of pigment in hair, eyelashes, eyebrows, or beard
• Depigmentation of mucous membranes (lips, gums, inside of mouth)
• Color change in the retina (rare)
• No physical pain, itching, or irritation in the patches themselves
• Patches may remain stable for years or slowly expand
• Sunburn vulnerability in depigmented areas (lack of UV protection from melanin)

Vitiligo is diagnosed clinically — no biopsy is required in most cases. Wood's lamp examination enhances the visibility of depigmented areas. Skin biopsy can confirm diagnosis in uncertain cases by demonstrating absence of melanocytes. Laboratory screening should include thyroid function tests, fasting glucose, CBC, and ANA given association with autoimmune comorbidities. Ophthalmology evaluation may be warranted if there is concern for retinal pigment abnormalities. Family history of vitiligo or other autoimmune conditions increases individual risk.

No treatment cures vitiligo, but multiple modalities promote repigmentation. Topical corticosteroids (high-potency on body, mid-potency on face) reduce immune attack and promote repigmentation; long-term use risks skin atrophy. Topical calcineurin inhibitors (tacrolimus ointment, pimecrolimus cream) are steroid-sparing alternatives especially safe for face and skin folds. Ruxolitinib cream 1.5% (Opzelura) — a JAK1/JAK2 inhibitor — was FDA-approved in 2022 for non-segmental vitiligo in patients ≥12 years and demonstrated meaningful facial repigmentation in the TRuE-V clinical trials; it is now a first-line option for localized and facial vitiligo. Narrowband UVB (NB-UVB) phototherapy is highly effective for widespread or generalized vitiligo and is typically delivered 3 times weekly in a dermatology setting or via home phototherapy units. Excimer laser targets small, stable patches. Surgical options — split-thickness skin grafting or melanocyte transplantation — are available for stable, localized segmental vitiligo. Depigmentation therapy (monobenzone cream) is used in rare cases of widespread disease where complete depigmentation is preferred for cosmetic uniformity. High-quality cosmetic camouflage products (DermaBlend, Vichy Dermablend, SpectraGuard) provide coverage while treatment proceeds. Mental health integration — therapy, support groups — is a core part of comprehensive vitiligo care.