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- Vitiligo causes patches lighter than your natural skin tone, white or pink, most often starting on the face, hands, arms or feet; active patches may itch.
- Nonsegmental vitiligo affects both sides of the body and is far more common; segmental vitiligo stays on one side, often starts in childhood and usually stops spreading.
- Dermatologists diagnose it by examining the skin, often under a Wood's lamp, and may order blood tests for thyroid and other autoimmune disease.
- Ruxolitinib cream is FDA-approved for nonsegmental vitiligo from age 12; steroid and calcineurin creams, light therapy and surgery are other options, and all take months.
Vitiligo is an autoimmune condition in which the immune system destroys the cells that make skin pigment, leaving patches that are lighter than your natural skin tone or milk-white. Early patches most often show up on the face, hands, arms or feet, can look pink or only slightly lighter at first, and may itch while they spread. Dermatologists split it into two main types: nonsegmental vitiligo, with patches on both sides of the body, and segmental vitiligo, which stays on one side or in one area.
Pori does not diagnose skin conditions. Its selfie scans and photo diary can help you keep dated, consistent photos of your face to show a dermatologist and to see whether treatment is bringing color back.
What are the early signs of vitiligo?
The first sign is usually one or more patches of skin that look lighter than the rest. The American Academy of Dermatology (AAD) describes them as areas of skin that look lighter than your natural skin tone, white, or even pink. While the condition is active, a patch can look three-toned, with a band of tan skin between your normal color and the white center. Once it stops being active, the patch turns completely white.
- Where it starts: the AAD lists the face, arms, hands and feet as the usual starting points, though patches can appear anywhere.
- Itch: patches may itch when they first appear or while they are spreading. Otherwise they rarely hurt.
- Hair: hair growing from a patch can lose its color. The AAD notes that vitiligo can also turn hair gray early, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) mentions the scalp, eyebrows and beard.
- Inside the mouth or nose: NIAMS says mucous membranes, such as the inside of the mouth or nose, can be affected too.
What does vitiligo look like on brown and black skin?
On brown and black skin, the contrast is high, so patches usually stand out as sharp, chalk-white areas with a clear edge. On very light skin, early patches can be hard to see at all. That is one reason dermatologists use a Wood's lamp, which DermNet says is especially useful in light-skinned people. If you have a deeper skin tone, our guide to causes of uneven skin tone covers the more common reasons for lighter and darker patches.
What is the difference between segmental and nonsegmental vitiligo?
Nonsegmental vitiligo is the common form. Its patches tend to appear on both sides of the body, often in a mirror pattern, for example both hands or both knees. Segmental vitiligo is much less common and stays on one segment or one side of the body. The difference matters because the two behave differently and are treated differently.
| Feature | Nonsegmental | Segmental |
|---|---|---|
| How common | Most cases | Much less common |
| Pattern | Both sides of the body, often symmetrical | One side or one area; does not cross the midline |
| Usual age at start | About half of cases begin before age 20 | Often childhood; 41% begin before age 10 |
| Course | Can stay stable or spread, unpredictably | Spreads quickly at first, then usually stops |
| Treatment notes | Ruxolitinib cream is FDA-approved for this type | Surgery is an option once the patch is stable |
The ages and course in this table come from DermNet's vitiligo overview. NIAMS adds that segmental vitiligo typically progresses for 6 to 12 months and then usually stops. Cleveland Clinic also describes rarer patterns: focal (a few patches in one small area), mucosal (the mouth or genitals) and universal (more than 80% of the skin).
What causes vitiligo, and who gets it?
NIAMS calls vitiligo a chronic (long-lasting) autoimmune disorder: the immune system attacks melanocytes, the cells that make pigment. DermNet estimates it affects 0.5 to 2% of the population, and it occurs in every skin tone. Anyone can get it at any age, though many people notice their first patch before 20.
- Family history raises the odds.
- Other autoimmune conditions are more likely. NIAMS lists thyroid disease, type 1 diabetes, Addison's disease, pernicious anemia, psoriasis, rheumatoid arthritis and lupus.
- Skin injury can set off new patches. DermNet calls this the Koebner phenomenon and lists cuts, friction, burns and other skin inflammation as triggers.
- Stress: Cleveland Clinic notes that emotional or physical stress may affect pigment production.
Vitiligo is not contagious. Cleveland Clinic states that it doesn't spread from person to person through physical contact.
How do doctors diagnose vitiligo with a Wood's lamp?
The AAD says a board-certified dermatologist diagnoses vitiligo by reviewing your medical history and examining your skin, and may use a Wood's lamp to get a better look. A Wood's lamp gives off long-wave ultraviolet (UVA) light. Healthy skin absorbs it, while skin without pigment glows bright white, which DermNet explains is because epidermal melanin, which normally absorbs UVA, is absent. The exam is quick, painless and done in a dim room. It also helps a dermatologist find faint patches and track how well treatment is working.
If the exam confirms vitiligo, the AAD says blood tests may be recommended, because they can find autoimmune diseases like thyroid disease.
What else causes white patches on the skin?
Several common conditions cause lighter skin. Most leave some pigment behind, so the patches look pale rather than milk-white. A dermatologist can usually tell them apart by looking, with a Wood's lamp or a quick skin scraping.
| Condition | Where it shows up | How it differs from vitiligo |
|---|---|---|
| Tinea (pityriasis) versicolor | Chest, back, shoulders | A yeast overgrowth with fine scale; patches are lighter or darker, rarely chalk-white, and a scraping shows yeast |
| Pityriasis alba | Cheeks of children and teens | Pale, slightly dry patches with soft edges, often in people with eczema |
| Idiopathic guttate hypomelanosis | Shins and forearms of older adults | Many small white spots a few millimeters wide that do not grow into large patches |
| Post-inflammatory hypopigmentation | Wherever a rash, burn or injury was | Follows earlier inflammation and usually fills in over months |
| Halo nevus | Around a mole, often on the back | A white ring around one mole; a dermatologist should look at the mole |
All five appear on DermNet's or Cleveland Clinic's lists of vitiligo look-alikes. See our guides to tinea versicolor and white spots on the face, and for pale patches in people with eczema, see eczema on the face.
How is vitiligo treated?
There is no cure yet, but NIAMS says treatments can be very effective at stopping the progression, and many people get some color back. Results depend on the area. The AAD says the face tends to respond well to treatment, while areas without hair, such as the fingertips, lips and toes, respond least. Treatment is slow, and color comes back gradually over months.
Ruxolitinib cream (Opzelura)
Ruxolitinib cream 1.5% is a JAK inhibitor applied to the skin. The FDA approved it in July 2022, and its current label covers the topical treatment of nonsegmental vitiligo in adult and pediatric patients 12 years of age and older. The AAD calls it the only medication approved by the U.S. Food and Drug Administration (FDA) to restore lost skin color in vitiligo. It is prescription-only, it is not approved for segmental vitiligo, and the label limits it to areas of up to 10% of body surface.
In the two trials behind the approval, about 30% of people using the cream reached at least a 75% improvement in facial vitiligo at 24 weeks, compared with about 8% and 13% on a cream without the drug, and nearly 50% reached it at week 52. The AAD advises telling your dermatologist if you see no new color after 24 weeks. The label carries a boxed warning about serious infections, cancer, heart events and blood clots, the warning that applies across JAK inhibitors, so go over your own health history with your dermatologist.
Corticosteroid creams and calcineurin inhibitors
A corticosteroid cream is often the first prescription. Because it can thin the skin, the AAD says dermatologists prescribe it for a limited time. Tacrolimus ointment and pimecrolimus cream do not thin skin, can be used for longer, and work best on the head and neck, which is why DermNet notes they are used on the face, eyelids and skin folds.
Light therapy
Narrowband UVB phototherapy treats larger areas, and a laser treats small ones. It takes many sessions over months. In a meta-analysis cited by DermNet, 36% of patients had a marked or useful response after 12 months of narrowband UVB.
Surgery, depigmentation and camouflage
For patches that have been stable for a while, especially segmental vitiligo, skin grafts or cell transplants can move pigment cells into the white area. Depigmentation removes the remaining color for an even tone; the AAD reserves it for people who have lost most of their natural color, and it is permanent. Makeup, self-tanner or skin dye can cover patches while treatment works. The AAD notes self-tanner lasts about 3 to 5 days.
Color can fade again after treatment ends. The AAD says that within a year of stopping treatment, about 40% of patients lose some color, so dermatologists often prescribe a maintenance plan.
How should you protect vitiligo patches from the sun?
Patches without pigment have no natural defense against UV, so they burn easily. Cleveland Clinic recommends sunscreen with an SPF of 30 or higher, shade during peak hours and protective clothing. Sunscreen also keeps the surrounding skin from tanning, which makes the contrast less visible. Our guides on how much sunscreen to use and what to do about a sunburned face cover the basics. Vitiligo can also weigh on mood and confidence, and Cleveland Clinic lists counseling as part of care.
When should you see a doctor about white patches?
See a dermatologist for any new light or white patch you can't explain, and sooner if:
- patches are appearing or spreading quickly;
- a child has white patches, especially on one side of the body;
- a pale patch feels numb, scaly or very itchy, which points to another cause;
- a white ring has formed around a mole;
- you also have signs of a thyroid problem or another autoimmune condition.
If you don't have a dermatologist, find a dermatologist near you. Taking clear photos in the same light every few weeks makes it much easier for both of you to judge whether patches are spreading or filling in.
Frequently asked questions
What does vitiligo look like when it starts?
It usually starts as one or more patches that are lighter than your natural skin tone, white or even pink, often on the face, hands, arms or feet. Active patches can look three-toned and may itch. Once a patch is no longer active, it turns completely white.
What is the difference between segmental and nonsegmental vitiligo?
Nonsegmental vitiligo is the common type and shows up on both sides of the body, often symmetrically, with an unpredictable course. Segmental vitiligo stays on one side or one area, often starts in childhood, spreads for a while and then usually stops.
What is a Wood's lamp test for vitiligo?
A Wood's lamp shines long-wave ultraviolet light on the skin in a dim room. Skin that has lost its pigment glows bright white, which helps a dermatologist see faint patches and track treatment. It is quick and painless.
Is ruxolitinib cream FDA-approved for vitiligo?
Yes. The FDA approved ruxolitinib cream 1.5% (Opzelura) in July 2022 for nonsegmental vitiligo in people 12 and older. It is prescription-only, covers up to 10% of body surface, and takes months to work.
Is vitiligo contagious?
No. Vitiligo is an autoimmune condition and does not spread from person to person through touch.
Can vitiligo be cured?
Not yet. Treatments such as prescription creams, light therapy and surgery can stop spread and bring back color, especially on the face, but color can fade after treatment stops, so many people need maintenance treatment.
Sources
- American Academy of Dermatology: Vitiligo signs and symptoms
- American Academy of Dermatology: Vitiligo diagnosis and treatment
- NIAMS: Vitiligo
- DermNet: Vitiligo
- Cleveland Clinic: Vitiligo
- DailyMed: Opzelura (ruxolitinib) cream prescribing information
- AJMC: FDA approves ruxolitinib cream as first repigmentation therapy for vitiligo
Pori is a wellness and skincare education app, not a medical device. This article is for general information and isn't medical advice. For anything that worries you, see a dermatologist.
