Vitiligo

The immune system destroying pigment cells, leaving pale patches. Physically harmless, and psychologically anything but.

What it is

Vitiligo affects around 1 in 100 people worldwide. The immune system destroys melanocytes, the cells that make pigment, leaving well-defined white patches.

It causes no physical symptoms, no pain and no illness. Which is exactly why it is dismissed as cosmetic, and why the psychological effect goes unaddressed.

The impact is heavily dependent on skin tone and on culture. On darker skin the contrast is stark, and in some communities vitiligo carries significant social stigma affecting marriage prospects and employment. Studies consistently find high rates of depression and anxiety.

It is associated with other autoimmune conditions, particularly thyroid disease, so thyroid function should be checked.

Signs you might notice

Well-defined patches of pale or white skin, often symmetrical.

Commonly around the eyes and mouth, on the hands, and in skin folds.

Patches that burn easily in sun, because there is no pigment to protect them.

White or grey hair growing within a patch.

Sometimes preceded by an area of skin injury, which is called the Koebner phenomenon.

Fatigue or weight change suggesting associated thyroid disease.

How it can affect day-to-day life

Sun protection is a genuine medical need, not a cosmetic one. Depigmented skin has no natural protection and burns quickly, raising skin cancer risk in those areas.

Treatment exists and is under-offered: topical steroids and calcineurin inhibitors, phototherapy, and newer JAK inhibitor creams. Repigmentation is slow, taking months, and works best on the face and where hair follicles remain.

Camouflage makeup is available on prescription in the UK through the Changing Faces Skin Camouflage Service, and a great many people have never been told.

Supporting someone well

Use high-factor sunscreen on affected areas every day, and cover up. This is medical, not vanity.

Ask for treatment rather than accepting that nothing can be done. Early treatment works better.

Get thyroid function checked, and repeat it periodically.

Ask about the NHS skin camouflage service for anybody who wants it.

Take the psychological impact seriously, particularly in adolescents and in communities where the stigma is significant.

Do not tell somebody it does not matter. That is their judgement to make, not yours.

Where to get help

A GP can start treatment, check thyroid function, and refer to dermatology.

The Vitiligo Society and Changing Faces both provide support, and Changing Faces run the skin camouflage service.

New rapidly spreading vitiligo warrants prompt dermatology review, since active disease responds better to treatment.