This condition is characterised by white patches appearing on the skin (known as depigmentation). It is caused by the body’s own immune system attacking melanocytes (pigment cells). Vitiligo can affect any area of the body in various patterns but often affects the hands, feet, body folds, genital area, lips and the area around the eyes. Where areas of hair-bearing skin are affected, it can cause the hairs to turn white. For some people vitiligo seems to worsen with stress or physical injury and can appear in any area of skin damage or injury, such as cuts scratches or sunburn (known as koebnerisation).
Vitiligo affects around 1% of the population, of all races and skin types, but may appear more noticeable in those with darker skin tones. The appearance of vitiligo can have a significant psychological impact and affect quality of life. For some cultural groups, the development of vitiligo can be devastating and it can affect the whole family unit.
Most people are otherwise well, but vitiligo can be associated with other autoimmune conditions. Thyroid disease in the patient or the family is the commonest association. Blood tests are not needed to diagnose vitiligo; however, the treating dermatologist may do blood tests to look for possible linked conditions.
Treatments at The Skin Hospital
- General measures. For some patients with fair skin, the best option may be high vigilance with sun protection measures, such as wearing protective clothing and using daily SPF 50+ sunscreens.
- Medical treatments. These include the use of steroid creams or ointments and steroid-sparing creams such as tacrolimus or pimecrolimus for affected skin in sensitive areas, such as the face.
- Physical therapy. Many patients respond to light therapy (NB-UVB), or your specialist may recommend combining light therapy with a photosensitising medication. Light therapy can be carried out at Westmead and Darlinghurst sites. Often extended courses are needed for a good benefit and a noticeable benefit is not usually seen before 3 months of therapy.
- Surgical treatments. For some people with stable vitiligo surgery can be an option – where a patient’s own skin or pigment cells are transplanted from unaffected skin into the skin affected by vitiligo. Techniques used for melanocyte transplantation include punch grafting, as well as suction blister grafting and novel cellular grafting techniques, which are all offered at The Skin Hospital.
- Camouflage. Skilled use of camouflage with specialist make-up products can help to cover up affected areas while waiting for the medical treatment to start working. A nurse-led camouflage clinic offers this service at Darlinghurst.
- Depigmenting therapy. Products derived from hydroquinone can be used to lighten the darker surrounding skin (to reduce contrast) in circumstances where the vitiligo is not responding to other treatments or when the vitiligo is particularly extensive or affecting areas such as the face.
- Excimer UV light. The Excimer UV-light targets the skin’s immune system to stimulate pigment cells to re-pigmentate in patients suffering from vitiligo.
- Other options. There is currently much research investigating treatments for vitiligo and our specialists will be able to discuss newly available treatment options with you. Excimer laser, which allows targeted treatment of small areas of vitiligo with a very specific wavelength of UVB will soon be available at The Skin Hospital.
- A local vitiligo support group is under development and will be launched over the coming months - the link will appear on The Skin Hospital website as soon as available.
Specialists available at The Skin Hospital with a special interest in vitiligo and pigmentary disorders:
- Dr Monisha Gupta (Darlinghurst)
- Dr Richard Wittal (Darlinghurst)
- Dr Phil Artemi (Westmead)
Links to trusted sites containing further information about vitiligo:
Dermnet also contains information on the specific treatments available:
Patient support groups, which may be helpful for patients and their families:
Vitiligo Association Australia: www.vitiligo.org.au
Vitiligo Support International: https://www.vitiligosupport.org/faq.cfm
Authors: Dr Charlotte Thomas & Dr Monisha Gupta, last updated 18 September 2015