Vitiligo is a loss of the pigment producing cells of the skin, either because they die or they quit working entirely. It can be caused by an autoimmune problem; that’s usually what we think of it is. There are viral triggers and there are family related triggers as well because we see it run in families sometimes.
There are two kinds of vitiligo. There’s segmental vitiligo which is uncommon. It affects part of the skin that’s innervated by spinal nerve route. And then there’s non-segmental vitiligo, which means it’s not part of a nerve route area of the skin and can affect mainly the hands, unfortunately the private areas of the body. It can really be anywhere on the skin. We often see it start on the hands or start in the private area of the bodies. Some vitiligo stops itself; the autoimmune reaction burns out. Some vitiligo continues until large parts of the body are encompassed by vitiligo. The face is also common, which is tragic.
Unfortunately, there is no cure for vitiligo at this time. The best treatment is to catch it early. It can be diagnosed easily by a biopsy. It can be diagnosed easily by an old tool called a woods lamp, which is really a black light, and it causes the vitiligo to stand out in a bluish white color and will also show us areas of the skin under the black light that are already depigmenting that are not visible to the naked eye. Treatment is difficult, and if we catch it early it works better. Treatment includes some steroid creams, some creams called calcineurin inhibitors that break up the autoimmune cycle and try to stop it. Works best when we also do it in combination with ultraviolet therapies especially the Excimer B laser, or the ultra-narrow-band UVB light.