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What Is Vitiligo? Causes, Types, Diagnosis

Heal House What is Vitiligo?

Vitiligo:
Why Skin Loses Its Color

Vitiligo is a hypopigmentary condition in which melanocytes in the skin are lost, resulting in white patches. It affects about 1% of the population worldwide. There are usually no subjective symptoms such as itching, but the visible patches can affect interpersonal relationships and quality of life. The darker the skin color, the more noticeable the patches may appear.

Heal House What is Vitiligo?

Vitiligo usually begins as white patches on areas that are frequently rubbed
or exposed to UV light
.

Vitiligo can appear anywhere on the skin, but it is commonly first noticed on the face, neck, hands, and arms, andit also frequently develops on areas where clothing rubs or there is frequent impact, such as the hairline, collarbone, waistline, armpits, navel, elbows, and knees.When gray hair appears at an early age, or the hair of the eyebrows, eyelashes, or other areas turns white, vitiligo can also be considered.Usually, there is no pain or itching, so it is difficult to notice until it becomes visible.

Heal House What is Vitiligo?

How is vitiligo different fromother hypopigmentation disorders?

  • The borders are very distinct, and the pigment is completely lost, turning white.

  • Under Wood's lamp examination, it appears as bright fluorescent white.

  • The hair in the affected area is also white.

  • It usually occurs symmetrically on both sides of the skin.

  • New patches may appear on areas of injury or friction.

Heal House What is Vitiligo?

Vitiligo: A Condition with Multiple Causes

It is not explained by a single cause.
It is understood that multiple factors work together.

Genetic Predisposition

More than 40 genes have been reported to be associated with vitiligo, but the concordance rate in identical twins is low, so genetics alone does not explain it.

Autoimmunity

It is considered a representative autoimmune skin disease in which the immune system mistakenly attacks melanocytes, leading to pigment loss.

Reduced Antioxidant Capacity

If melanocytes cannot adequately remove reactive oxygen species, accumulated oxidative stress can cause the cells to be easily lost.

External Triggers (Koebner Phenomenon)

There is a hypothesis (the melanocyte loss hypothesis) that because melanocytes have weak adhesion, lesions are more likely to occur in areas of repeated friction or pressure.

Environmental Factors

Representative chemical substances such as hair dye, rubber, and plastic products, as well as physical trauma such as wounds, friction, and scars after surgery, as well as strong ultraviolet exposure, can induce damage to melanocytes and promote the development and worsening of vitiligo.

Intrinsic Vulnerability of Melanocytes

Melanocytes in vitiligo patients may be inherently more vulnerable both structurally and functionally than those of people without vitiligo. Therefore, they can be easily damaged or die off even with mild external stimuli or stress. In fact, signs of aging and functional impairments in intracellular structures are commonly observed in the melanocytes of vitiligo patients.

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Six Types of Vitiligo by Distribution Pattern

Vitiligo is divided into six types based on distribution pattern. The progression and treatment response vary by type.

Illustration of the body distribution of localized vitiligo

Localized

Illustration of the body distribution of segmental vitiligo

Segmental

Illustration of the body distribution of acrofacial vitiligo

Acrofacial

Illustration of the body distribution of generalized vitiligo

Generalized

Illustration of the body distribution of mixed vitiligo

Mixed type

Illustration of the body distribution of universal vitiligo

Universal

Heal House What is Vitiligo?

Facial Vitiligo: Three Patterns

Even for the same facial vitiligo, management methods differ depending on where it starts and how it spreads.
Facial vitiligo varies by type in terms of onset factors, timing, response to phototherapy, and disease course.

Illustration of the distribution of facial medial vitiligo, starting around the eyes, nose, and mouth and spreading to the hairline

Centrofacial

Illustration of the distribution of facial generalized vitiligo, appearing across the entire face including the forehead, both cheeks, and temples

Whole Face

Illustration of the distribution of hairline-limited vitiligo, confined to the hairline

Frontal line-limited

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Three Goals of Vitiligo Treatment

Stop the spread, restore color, and prevent it from spreading again.

Stops progression

Stop Progression

Keep vitiligo fromspreading any further.

Restores color

Restore Color

Help the white skinregain its original color.

Prevents recurrence

Prevent Recurrence

After improvement, we manage it to preventit from spreading again.

Heal House What is Vitiligo?

Vitiligo: Myths and Facts

Treatment may not be easy, but it is not impossible. There are stepwise treatment options, including phototherapy, excimer laser, medications, and pigment cell transplantation surgery during the stable phase. Starting earlier makes it easier to monitor the course.

There is a genetic predisposition, but it does not develop from genetics alone—environmental factors also play a role. Even if there is a family history, it does not appear in most descendants, so there is no need to worry excessively if a family member has it.

Vitiligo is not an infectious disease and cannot be transmitted through everyday contact such as touching, sharing meals, or swimming. There are no medical restrictions in daily life or interpersonal relationships.

Vitiligo is an autoimmune skin disease caused by the immune system attacking pigment cells. Autoimmune diseases such as thyroid disorders and alopecia areata can occur together, so an accurate diagnosis is necessary. Moreover, because the visible spots can affect interpersonal relationships and quality of life, it should be treated as a disease.

The course varies from person to person. It may remain small in one or two spots, or it may spread gradually. Therefore, it is important to determine the type and whether it is progressing, and to respond with timely treatment.

There are no specific foods that must be avoided. A balanced diet is fundamental, and fruits and vegetables rich in antioxidants may be helpful. Rather than relying on unverified dietary regimens, it is better to combine treatment with lifestyle management.

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Diagnosis Is the First Step to Treatment

Not all white spots on the skin are vitiligo.Many conditions look similar, such as pityriasis alba, nevus depigmentosus, idiopathic guttate hypomelanosis, tinea versicolor,and post-inflammatory hypopigmentation.Accurately differentiating these hypopigmented conditions is the starting point of treatment.

  1. A 365 nm ultraviolet light is used to clearly reveal vitiligo patches as bright white.

  2. By filtering out surface glare from the skin, the natural color is observed, and changes in pigment and blood vessels are distinguished.

  3. Combining a Wood's lamp with a special camera, even early lesions that are not yet clearly visible are detected.

  4. Subtle changes beneath the epidermis are examined, and white hairs within the lesion are observed to predict treatment response.

  5. Repeated photographs are taken at the same angle and lighting to accurately document changes over time.

  6. Vitiligo can be associated with autoimmune diseases such as thyroid disorders, so blood tests are used to check for them.

Heal House What is Vitiligo?

Frequently Asked Questions in the Clinic