DermNet NZ

Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


What is vitiligo?

Vitiligo is an acquired depigmenting disorder of the skin, in which pigment cells (melanocytes) are lost. It presents with well-defined milky-white patches of skin. Vitiligo can be cosmetically very disabling, particularly in people with dark skin.

Who gets vitiligo?

Vitiligo affects 0.5–1% of the population, and occurs in all races. It may be more common in India, with reports of up to 8.8% of the population affected. In 50% of sufferers, pigment loss begins before the age of 20, and in about 80% it begins before the age of 30 years. In 20%, other family members also have vitiligo. Males and females are equally affected.

Even though most people with vitiligo are in good general health, they face a greater risk of having autoimmune diseases such as diabetes, thyroid disease (in 20% of patients over 20 years with vitiligo), pernicious anaemia (B12 deficiency), Addison disease (adrenal gland disease), systemic lupus erythematosus, rheumatoid arthritis, psoriasis, and alopecia areata (round patches of hair loss).

What causes vitiligo?

Vitiligo is due to loss or destruction of melanocytes, which are the cells that produce melanin. Melanin determines the colour of skin, hair, and eyes. If melanocytes cannot form melanin or if their number decreases, skin colour becomes progressively lighter.

The exact cause of vitiligo is unknown. It is thought to be a systemic autoimmune disorder, associated with deregulated innate immune response, although this has been disputed for segmental vitiligo. There is a genetic susceptibility and vitiligo is a component of some rare syndromes. The gene encoding the melanocyte enzyme tyrosinase, TYR, is likely involved.

There are three theories on the cause of vitiligo:

Current investigations are evaluating the pattern of cytokines (messenger proteins) and the role of the hair follicle in repigmentation.

What are the clinical features of vitiligo?

Vitiligo can affect any part of the body. Complete loss of pigment can affect a single patch of skin or it may affect multiple patches. Small patches or macules are sometimes described as confetti-like.

The colour of the edge of the white patch can vary.

The severity of vitiligo differs with each individual. There is no way to predict how much pigment an individual will lose or how fast it will be lost.

Mucosal vitiligo
Mucosal vitiligo
Acral vitiligo
Acral vitiligo
Segmental vitiligo
Segmental vitiligo
Koebnerised vitiligo
Koebnerised vitiligo
Trichrome vitiligo
Trichrome vitiligo
Vitiligo with leukotrichia or poliosis
Vitiligo with red border
Red border
Vitiligo with follicular repigmentation
Follicular repigmentation

More images of vitiligo ...

How is vitiligo classified?

Classifications have identified clinical, genetic, pathobiological, epidemiological, and molecular characteristics of vitiligo.

The Vitiligo European Taskforce came to a consensus about classification of vitiligo in 2007. They decided on 4 main categories with subtypes.

Classification Subtype Comments
Nonsegmental vitiligo
  • Focal
  • Mucosal
  • Acrofacial
  • Generalised
  • Universal
  • Tends to be bilateral and symmetrical in distribution.
  • Stable or unstable
Segmental vitiligo
  • Focal
  • Mucosal
  • Unisegmental, bi- or multisegmental
  • Single white patch in 90%
  • Border often irregular
  • Young people
  • Stable after first year
  • Cutaneous mosaicism (Blaschko, dermatomal, phylloid, checkerboard patterns)
Mixed vitiligo
  • Nonsegmental combined with segmental vitiligo
  • Rare
Unclassified vitiligo
  • Focal at onset
  • Multifocal asymmetrical non-segmental
  • Unifocal mucosal
  • Early disease

How is the severity of vitiligo assessed?

In most cases the severity of vitiligo is not formally assessed. However, clinical photographs may be taken to monitor the condition.

At least 2 scoring systems have been devised for vitiligo and are used in clinical trials.


VASI is based on the PASI scoring system for psoriasis. It measures the extent and degree of depigmentation in 6 sites: hands, upper extremities, trunk, lower extremities and feet, head/neck.


VETF is based on SCORAD scoring system for atopic dermatitis. The VETF assesses extent, staging and spreading/progression in 5 sites: head/neck, trunk, arms, legs and hands/feet. It grades from 0 (normal pigmentation) to 4 (complete hair whitening). Spreading is assessed using the following scores: 0 (stable disease), -1 (regressive disease) and +1 (progressive disease).

VETF includes a clinical assessment form to record the sex, age, duration of disease, age of onset, episodes of repigmentation, impact of vitiligo on quality of life, family history, additional medical conditions and the Fitzpatrick skin type of the patients.

How is vitiligo diagnosed?

Vitiligo is normally a clinical diagnosis, and no tests are necessary to make the diagnosis. The white patches may be seen more easily under Wood lamp examination (black light).

Occasionally skin biopsy may be recommended, particularly in early or inflammatory vitiligo, when a lymphocytic infiltration may be observed. Melanocytes and epidermal pigment are absent in established vitiligo patches.

Blood tests to assess other potential autoimmune diseases or polyglandular syndromes may be arranged, such as thyroid function, B12 levels and autoantibody screen.

Clinical photographs are useful to document the extent of vitiligo for monitoring. Serial digital images may be arranged on follow-up. The extent of vitiligo may be scored according to the body surface area affected by depigmentation.

Precautions that should be taken by people with vitiligo

Minimise skin injury

Those prone to vitiligo should be careful to minimise skin injury, as it is common for healing to result in a new white patch at the site. The injury might be a cut, a graze, a scratch, or an area prone to rubbing. New depigmentation often develops with a linear shape.

Protect against sun exposure

The white skin needs careful sun protection because it can only burn on exposure to ultraviolet radiation (UVR); it cannot tan. The normal skin also needs protecting to prevent sunburn (which could cause spreading of the vitiligo), and to reduce the contrast in colour between the normal skin and the vitiligo.

Sunburn in vitiligo Sunburn in vitiligo
Images supplied by Dr Shahbaz A. Janjua
Sunburn in vitiligo

How is vitiligo treated?

Treatment of vitiligo is currently unsatisfactory. Repigmentation treatment is most successful on face and trunk; hands, feet and areas with white hair respond poorly. Compared to longstanding patches, new ones are more likely to respond to medical therapy.

When successful repigmentation occurs, melanocyte stem cells in the bulb at the base of the hair follicle are activated and migrate to the skin surface. They appear as perifollicular brown macules.

General measures

Minimise skin injury: wear protective clothing

Sun protection: stay indoors when sunlight is at its peak, cover up and apply SPF 50+sunscreen to exposed skin.

Cosmetic camouflage can disguise vitiligo. Options include:

Topical treatments

Topical treatments for vitiligo include:


Phototherapy refers to treatment with ultraviolet (UV) radiation. Options include:

Phototherapy probably works in vitiligo by 2 mechanisms.

Treatment is usually given twice weekly for a trial period of 3–4 months. If repigmentation is observed, treatment is continued until repigmentation is complete or for a maximum of 1–2 years.

Systemic therapy

Systemic treatments for vitiligo include:

It is anticipated that monoclonal antibody biologic agents will be developed to treat vitiligo.

Surgical treatment of stable vitiligo

Surgical treatment for stable and segmental vitiligo requires removal of the top layer of vitiligo skin (by shaving, dermabrasion, sandpapering or laser) and replacement with pigmented skin removed from another site.

Techniques include:

Depigmentation therapy

Depigmentation therapy, using monobenzyl ether of hydroquinone, may be considered in severely affected, dark skinned individuals.

Cyotherapy and laser treatment (eg 755 nm Q-switched alexandrite or 694 nm Q-switched ruby) have also been used successfully to depigment small areas of vitiligo.

Psychosocial effects of vitiligo

Vitiligo results in reduced quality of life and psychological difficulties in many patients, especially in adolescents and in females. The psychosocial effects of vitiligo tend to be more severe in some countries, cultures and religions than in others. Family support, counselling and cognitive behavioural treatment can be of benefit.

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Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Updated August 2015.

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.