Vitiligo is a chronic skin pigmentation disorder that produces whiter or lighter areas of skin almost anywhere on the body. The condition can also be accompanied by other symptoms and possible complications.
While vitiligo is not life threatening in and of itself, a diagnosis from a dermatologist (a doctor who specializes in skin, hair, and nails) is essential to treating the condition and preventing associated health risks.
A diagnosis of vitiligo usually includes an analysis of your symptoms and medical history, a physical exam of the skin, and possibly a skin biopsy or blood test. Your doctor will first need to rule out other conditions that may be causing changes to your skin.
You may also need to be screened for other health problems. Research has shown that you have a higher chance of developing other autoimmune diseases when you have vitiligo.
Some people find that the appearance of their skin affects their self-esteem. Vitiligo treatment can also include working with a psychiatrist.
There are no home tests available to diagnose vitiligo. However, you can do a general self-exam of your skin and find uneven or widespread pigmentation loss (discoloration of the skin, hair, and eyes).
The main symptom of vitiligo is white or lighter patches on the skin. These changes are clearly visible. Regular monitoring of your skin, such as after bathing or changing clothes, can help you detect the condition early and seek a diagnosis from a dermatologist .
Here are some of the most common signs of vitiligo that you can check for:
- Generalized or patchy loss of skin color that usually begins to appear in areas exposed to sunlight, such as the hands, arms, feet, face, or skin folds (elbows, knees, or groin).
- Premature discoloration of hair on the scalp, eyelashes, eyebrows or face.
- Loss of color inside the mouth or nose ( mucous membranes ).
- Changes or loss of pigmentation in the color of the eyes.
- Pain, itching, or discomfort in areas of the skin where white or light patches appear.
You can also mark where white or light spots appear. Doctors classify vitiligo based on the general location of the loss of pigmentation.
In general, these categories include:
- Non-segmental Vitiligo – This is the most common type of vitiligo. The white spots are usually symmetrical, which means that they appear on both sides of the body.
- Segmental Vitiligo: This less common type of vitiligo affects only one segment (area) of the skin and usually stops growing after the initial patch appears.
If you are doing an initial self-check for skin depigmentation and you notice changes, the next step is to make an appointment with your doctor. This doctor will be able to refer you to a dermatologist for a more complete examination.
Vitiligo can begin to develop at any stage of life, but most people will notice it before age 30. Note that skin depigmentation may be due to other conditions and may not be vitiligo.
The physical exam to diagnose vitiligo begins in the doctor's office. They will first ask about your symptoms and take your medical history. They will then do a physical exam of your skin.
Medical and family history
Here are some of the things your doctor is likely to ask you about:
- Symptom history: You will be asked when you first noticed potential vitiligo spots on your skin, if the spots have grown, and if they have spread to different areas. Depending on your age, they may also ask if your hair turned gray before age 35.
- Family history of vitiligo: In some people, vitiligo has a genetic component. Experts estimate that about 20% of people with vitiligo have close relatives with the condition.
- Family history of autoimmune diseases: Vitiligo is associated with autoimmune diseases. Your doctor may ask if your family member has been diagnosed with an autoimmune disorder such as rheumatoid arthritis (RA), lupus , or thyroid disease.
- Previous skin problems: for example, severe sunburn , a rash or other injury (such as forceful rubbing, rubbing, or scratching) in areas where white or light patches appear.
- Stress levels: Situations that cause physical, mental and emotional stress, both in the present and in the recent past, can contribute to the development of vitiligo.
After the medical history and symptoms part of the consultation, your doctor will examine your skin. This will be a more comprehensive exam than the skin exam you may have done at home.
Your doctor will look closely at all areas of your skin and note where the depigmentation spots appear, if they are symmetrical or random, and if they are in areas primarily exposed to the sun.
Some doctors use a special light known as a Wood's lamp to detect white or light patches of vitiligo. Wood's lamp uses ultraviolet light in a dark room to illuminate areas of the skin. Vitiligo spots turn fluorescent under lamplight.
Laboratories and tests
If doctors need more information before making a diagnosis, they can perform skin biopsies or blood tests to detect any underlying autoimmune diseases or other skin conditions.
A skin biopsy involves the removal of a small portion of the affected skin tissue to check for the presence of pigment cells ( melanocytes ) in the skin. The skin sample will be examined under a microscope in a laboratory. If you show a lack of pigment cells, the diagnosis of vitiligo will likely be confirmed.
Very rarely, a form of skin cancer called cutaneous hypopigmented T-cell lymphoma can cause white patches similar to vitiligo. Discoloration occurs due to the malfunctioning of pigment cells. A skin biopsy can rule out this possibility.
About 15 to 25% of people with vitiligo have at least one other autoimmune disease. Your doctor may order blood tests to assess your general health and specific problem areas, such as thyroid function.
Vision or hearing exams
Vitiligo can affect vision and hearing, although this is rare.
If you have symptoms related to vision or hearing, a dermatologist may refer you to an ophthalmologist (a doctor who specializes in vision) to check for inflammation of the eyes (uveitis), or an audiologist (a doctor who specializes in audition) to verify your audience.
Your doctor may take clinical photographs of your skin to document possible vitiligo for future follow-up and potential treatment.
If there are multiple possible conditions that could be causing skin symptoms, your dermatologist will use a differential diagnostic process to confirm the cause.
Doctors use information from your descriptions of symptoms, medical history, physical examination, test results, and personal experience with skin conditions to narrow down the list in the elimination process.
Vitiligo is not the only cause of skin depigmentation. If your symptoms or test results don't match a typical case of vitiligo, your dermatologist can look for other conditions.
Other skin pigmentation disorders include:
- Versicolor versicolor – This common fungal infection (versicolor versicolor) is caused by an overgrowth of naturally occurring yeast on the skin. The main sign of pityriasis versicolor is some areas of discolored skin and sometimes mild itching.
- Albinism : The main symptom of albinism is a lack of hair, skin, or eye color. This genetic disorder occurs when the body cannot make melanin (the pigment that gives skin its color). Albinism can affect the entire body, small areas of the skin, hair, and eyes.
- Hypopigmentation: This is a condition where the skin becomes lighter due to a reduced amount of melanin. It can be caused by previous trauma to the skin, exposure to chemicals, infection, and sometimes inflammatory skin conditions such as psoriasis or eczema (atopic dermatitis).
- Lichen: This is a common, benign skin disorder that generally affects children under the age of 12. It is characterized by raised, rounded patches of fair skin that are usually visible on the face, although it can occur on other parts of the body as well.
- Chemical leukoderma – Exposure to some harsh chemicals can damage the skin and cause white or light patches.
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The diagnosis of vitiligo is just the beginning of living with the condition. Some people with vitiligo have additional symptoms of skin pigmentation changes and may have other autoimmune diseases as well.
Vitiligo can negatively affect a person's quality of life due to the possible psychological consequences of skin changes and social stigma.
The American Academy of Dermatology recommends looking for a board-certified dermatologist in your area. Board-certified dermatologists are trained to help you manage your condition and refer you to specialists as needed, such as mental health care.