Vitiligo: Signs and symptoms

Vitiligo causes loss of color. Your dermatologist may call this “loss of pigment” or “depigmentation.” We can lose pigment anywhere on our bodies, including our:

• Skin.
• Hair (scalp, eyebrow, eyelash, beard).
• Inside the mouth.
• Genitals.

Most people who get vitiligo lose color on their skin. The affected skin can lighten or turn completely white. Many people do not have any other signs or symptoms. They feel healthy.

A few people say that the skin affected by vitiligo itches or feels painful.

Vitiligo. It is common to have vitiligo on the hands.

Vitiligo can progress. With time, some people see their vitiligo cover a large area.

Vitiligo can affect hair. The white hair near this 22-year-old man's part is due to vitiligo.

Living with vitiligo can cause other symptoms such as low self-esteem and depression that is hard to beat. This can happen regardless of the amount of color loss or type of vitiligo.

Vitiligo has types and subtypes

If you are diagnosed with vitiligo, your dermatologist may tell you what type and subtype you have.

Types: Today, most doctors recognize two types:

Type	Traits
Segmental vitiligo Also called: Unilateral vitiligo	Appears on 1 segment of the body, such as a leg, face or arm. About half of people lose some hair color, such as on the head, an eyelash or an eyebrow. Often begins at an early age. Often progresses for a year or so then stops.
Non-segmental vitiligo Also called: Bilateral vitiligo Vitiligo vulgaris Generalized vitiligo	Most common type. Appears on both sides of the body, such as both hands or both knees. Often begins on hands, fingertips, wrists, around the eyes or mouth, or on the feet. Often begins with rapid loss of skin color, which then stops for a while. Color loss often starts up later. This start-and-stop cycle usually continues throughout a person's lifetime. Color loss tends to expand, growing more noticeable and covering a larger area.

Types of vitiligo. The child on the left has the most common type, non-segmental vitiligo. The child on the right has segmental vitiligo.

Images used with permission of Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2010; 62:945-9)

Subtypes: The subtype tells you how much vitiligo appears on the body. The vitiligo subtypes are:

• Localized: One or a few spots or patches appear, but these are limited to one or a few areas of the body.
• Generalized: Most people develop this subtype, which causes scattered patches on the body.
• Universal: Most pigment is gone. This is rare.

There is no way to predict how much color a person will lose. Color loss can remain unchanged for years. Some people see patches enlarge and new patches appear. On a rare occasion, the skin regains its lost color.

Images 1, 2, and 3 used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Image 4 used with permission of Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2010; 62:945-9)

References:

Halder RM, Taliaferro SJ. “Vitiligo.” In: Wolff K, Goldsmith LA, Katz SI, et al. editors. Fitzpatrick’s Dermatology in General Medicine, 7th ed. United States of America, McGraw Hill Medical; 2008. p.616-21.

Mazereeuw-Hautier J, Bezio S, Mahe E et al. “Segmental and nonsegmental childhood vitiligo has distinct clinical characteristics: a prospective observational study.” J Am Acad Dermatol; 62: 945-9.

Ortonne JP, “Vitiligo and Other Disorders of Hypopigmentation.” In: Bolognia JL, Jorizzo JL, Rapini RP, et al. editors. Dermatology, 2nd ed. Spain, Mosby Elsevier; 2008. p. 913-20.