Vitiligo

Vitiligo is a long-term skin condition characterized by patches of depigmented skin caused by the loss of functional melanocytes in the epidermis. The patches are usually well defined and can occur anywhere, but are most noticeable on the face, hands, arms, and areas of friction. The condition may also affect hair, leading to white or gray hair in the affected areas, and can involve mucous membranes in rare cases. Vitiligo is generally not painful or dangerous, but it can have psychological and cosmetic impacts due to visible changes in appearance.

Most cases are considered autoimmune in origin, occurring in people with a genetic predisposition. An autoimmune attack against melanocytes leads to their destruction in affected skin. Environmental triggers and stress may contribute, and vitiligo often runs in families. The condition can be associated with other autoimmune diseases such as thyroid disorders, type 1 diabetes, pernicious anemia, and alopecia areata.

Diagnosis is typically based on clinical appearance. A Wood’s lamp examination can help distinguish depigmented areas from hypopigmented ones by illuminating the patches. Differential diagnoses include fungal infections (tinea versicolor), post-inflammatory hypopigmentation, and other pigmentary disorders. Blood tests or skin biopsies are not routinely required but may be used if an associated autoimmune condition is suspected or to rule out other causes.

Treatment aims to halt progression and promote repigmentation, though there is no cure. Options include topical corticosteroids or calcineurin inhibitors, phototherapy with narrowband UVB or PUVA, and, in some regions, topical or systemic JAK inhibitors. In stable disease, surgical approaches such as skin grafts or melanocyte transplantation can be considered. Supportive measures include sunscreens, camouflage makeup, and psychological support. The course is highly variable; some individuals experience stabilization and partial repigmentation, while others may have progression.