Vitiligo risk factors: who is more likely to get it and why

What vitiligo is

Vitiligo is a chronic (long-lasting) autoimmune disorder that causes patches of skin to lose pigment or color. It happens when melanocytes, the skin cells that make pigment, are attacked and destroyed, and the skin turns a milky-white color (NIAMS).

The white patches usually appear on both sides of the body, such as on both hands or both knees. A much less common type, segmental vitiligo, affects only one segment or side of the body, such as a leg, an arm or one side of the face; it often starts at an early age, progresses for 6 to 12 months and then usually stops (NIAMS).

There is no score or calculator on this page; the factors below are the ones NIAMS and MedlinePlus name.

Who is more likely to get vitiligo

Anyone can get vitiligo, at any age. For many people the white patches begin before age 20, and they can start in early childhood (NIAMS). MedlinePlus says it usually starts before age 40 (MedlinePlus).

NIAMS says vitiligo seems to be more common in people who have a family history of the disorder or who have certain autoimmune diseases (NIAMS):

• Addison's disease
• Pernicious anemia
• Psoriasis
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Thyroid disease (see hypothyroidism risk factors)
• Type 1 diabetes

MedlinePlus likewise says vitiligo is more common in people with autoimmune diseases and that it might run in families (MedlinePlus). People with vitiligo may also be more likely to develop other autoimmune disorders (NIAMS). NIAMS lists vitiligo among the autoimmune diseases that make alopecia areata more likely (NIAMS).

What causes it

Scientists believe vitiligo is an autoimmune disease in which the immune system attacks and destroys the melanocytes, and researchers are still studying how family history and genes may play a role (NIAMS). MedlinePlus says no one knows what destroys these cells (MedlinePlus).

Sometimes an event, such as a sunburn, emotional distress or exposure to a chemical, can trigger vitiligo or make it worse (NIAMS).

Symptoms

The main symptom is loss of natural color, called depigmentation. It can affect (NIAMS):

• Skin, with milky-white patches, often on the hands, feet, arms and face, though they can appear anywhere.
• Hair, which can turn white where the skin is losing pigment, including the scalp, eyebrows, eyelashes, beard and body hair.
• Mucous membranes, such as the inside of the mouth or nose.

MedlinePlus adds that patches are more common where skin is exposed to the sun, that vitiligo can cause hair to gray early, and that people with dark skin may lose color inside the mouth (MedlinePlus). People with vitiligo can also develop low self-esteem or a poor self-image, uveitis (inflammation in the eye) and inflammation in the ear (NIAMS).

Diagnosis

A doctor asks about your family history and does a thorough physical exam, sometimes using a Wood's lamp (a black light) that makes affected skin look chalky and bright. Other tests can include blood tests for other autoimmune diseases, an eye exam for uveitis, and a skin biopsy (NIAMS).

Treatment and living with vitiligo

There is no cure, but treatments can be very effective at stopping its progression and reversing its effects (NIAMS). Treatments take time, not everyone responds, results can vary by body area, and new patches may appear in the meantime. Options include (NIAMS):

• Medicines or medicated skin creams, such as corticosteroids or a calcineurin inhibitor
• Light therapy (phototherapy), with light boxes for large areas and lasers for smaller ones
• Depigmentation, usually for people with vitiligo on more than half of the body
• Surgery, for long-standing segmental vitiligo or when other treatments do not work

NIAMS suggests protecting your skin from the sun with sunscreen and clothing, using cosmetics such as self-tanning lotions or dyes (ask your doctor which), finding a doctor experienced with vitiligo, and seeking support. Living with vitiligo can be hard, and changes in appearance can lead to low self-esteem and depression; a mental health professional can help (NIAMS). See depression risk factors.

Common questions

Is vitiligo genetic?

It may run in families, and a family history makes it more common, but researchers are still studying how family history and genes play a role (NIAMS) (MedlinePlus).

Is vitiligo an autoimmune disease?

Yes. NIAMS describes it as an autoimmune disorder in which the immune system attacks the pigment-making cells by mistake (NIAMS).

At what age does vitiligo start?

It can start at any age. For many people it begins before age 20, and MedlinePlus says it usually starts before age 40 (NIAMS) (MedlinePlus).