Vitiligo: Causes, Treatment,
and Repigmentation

Vitiligo is a condition in which the immune system destroys melanocytes, the cells that make skin pigment, leaving smooth white patches. It affects about 1 percent of people worldwide, is not contagious, and is not caused by anything the patient did. Vitiligo is treatable: topical anti-inflammatory creams, the newer prescription cream ruxolitinib, and narrowband UVB phototherapy can restore color to many patches, especially on the face and when treatment starts early. Belaray Dermatology diagnoses and treats vitiligo in adults and children at its Hicksville and Stony Brook offices.

What Is Vitiligo?

Skin color comes from melanin, made by melanocytes in the outer layer of the skin. In vitiligo, the immune system attacks these cells, and the areas where they are lost turn milky white. The patches have sharp edges, do not itch or scale, and can appear anywhere, most often on the face, hands, elbows, knees, feet, and around body openings. Hair growing from a patch can turn white as well. Vitiligo often begins before age 30, affects all skin tones equally, and is more visible in darker skin.

There are two main patterns:

• Non-segmental (generalized) vitiligo is the common form. Patches appear on both sides of the body, often symmetrically, and tend to spread slowly over years with periods of stability and periods of activity.
• Segmental vitiligo affects one side or one segment of the body, usually begins in childhood, spreads for a year or two, and then stops. It responds less well to medication and better to surgical grafting once stable.

What Causes Vitiligo?

Vitiligo is an autoimmune condition. Genetics account for a large share of the risk, and about one in five patients has a relative with it. Vitiligo is associated with other autoimmune conditions, most often thyroid disease, and a dermatologist will usually check thyroid function at diagnosis. Flares can be triggered by skin injury, sunburn, friction, or emotional stress, a response called the Koebner phenomenon, which is why new patches sometimes appear at the site of a cut, a scrape, or a tight waistband. Vitiligo is not caused by diet, hygiene, or infection, and it cannot be passed to another person.

How Is Vitiligo Diagnosed?

A dermatologist can usually diagnose vitiligo by examining the skin. A Wood’s lamp, an ultraviolet light used in a darkened room, makes vitiligo patches glow bright white and reveals early patches that are hard to see in ordinary light. The exam also rules out look-alikes such as tinea versicolor (a yeast infection that causes lighter patches with fine scale), pityriasis alba (pale patches in children with dry skin or eczema), post-inflammatory hypopigmentation after a rash or injury, and nevus depigmentosus (a stable birthmark). A biopsy is rarely needed. Blood tests for thyroid function and sometimes vitamin B12 and other autoimmune markers are often ordered at the first visit.

How Is Vitiligo Treated?

Treatment aims to stop the immune attack and stimulate remaining melanocytes, usually from hair follicles, to repopulate the patch. Color returns gradually, often first as small freckle-like spots around the follicles that merge over months. The face and neck respond best; the hands, feet, and lips respond least. Treatment is more effective when started while patches are new.

Topical Treatments

• Topical corticosteroids of moderate to high strength are the usual first step for small areas on the body, used in cycles to avoid thinning the skin.
• Topical calcineurin inhibitors (tacrolimus ointment, pimecrolimus cream) are preferred for the face, eyelids, and skin folds because they do not thin the skin and can be used long term.
• Ruxolitinib cream (Opzelura), a topical JAK inhibitor, is the first medication FDA-approved specifically for repigmentation in non-segmental vitiligo. It is approved for ages 12 and up on up to 10 percent of the body surface, applied twice daily. In clinical trials, about 30 percent of patients regained 75 percent or more of facial pigment at six months, and results continued to improve through one year.

Narrowband UVB Phototherapy

Narrowband UVB is the most effective treatment for widespread vitiligo. Patients stand in a light cabinet for a few minutes two or three times a week; the light calms the immune attack and stimulates melanocytes. Visible repigmentation usually begins after two to three months, and a full course runs six to twelve months or longer. Combining phototherapy with a topical treatment improves results. Belaray offers narrowband UVB phototherapy, and treatment plans are coordinated with your dermatologist so each session builds on the last.

Other Options

• Oral treatment for rapidly spreading vitiligo: short courses of oral corticosteroids or, increasingly, oral JAK inhibitors under a dermatologist’s supervision to halt active disease.
• Surgical grafting for stable segmental or limited vitiligo that has not responded to medication, in which pigment cells are transplanted from normally colored skin.
• Depigmentation for the small number of patients with vitiligo over most of the body, in which the remaining pigment is removed to even the skin tone.
• Camouflage: medical-grade cover creams and self-tanners (dihydroxyacetone) temporarily color patches and are safe to use alongside treatment.

What Results Can I Expect?

Most patients who are treated consistently see meaningful repigmentation, especially on the face, neck, and trunk. Repigmentation is slow, measured in months, and some areas, particularly the fingers, toes, and lips, may not respond. Color that has returned can be lost again during a future flare, so a maintenance plan, usually a twice-weekly topical, is part of long-term care. Vitiligo is not dangerous to physical health, but its effect on confidence and mood is real and is a legitimate reason to treat it.

When Should I See a Dermatologist?

• Any new white or lighter patch of skin, to confirm whether it is vitiligo or one of its look-alikes.
• Patches that are spreading, since early treatment of active vitiligo gives the best results.
• Vitiligo together with fatigue, weight change, or other symptoms that could suggest thyroid disease.
• A child with white patches, who may have vitiligo, pityriasis alba, or a birthmark that needs no treatment.

Frequently Asked Questions

Can vitiligo be cured?

There is no permanent cure, but vitiligo can be treated effectively. Topical anti-inflammatory creams, ruxolitinib cream, and narrowband UVB phototherapy stop the immune attack and restore color to many patches, especially on the face and when treatment starts early. Repigmentation can be lost in a later flare, so maintenance treatment is usually continued.

Does vitiligo spread?

Often, yes. Non-segmental vitiligo tends to spread slowly over years, with periods of stability and periods of activity, and new patches can appear at sites of skin injury, friction, or sunburn. Segmental vitiligo usually spreads for one to two years and then stops. Active, spreading vitiligo is the most important reason to start treatment promptly.

Is vitiligo contagious or caused by something I did?

No. Vitiligo is an autoimmune condition driven by genetics and the immune system. It cannot be passed to another person by touch or any other contact, and it is not caused by diet, hygiene, stress alone, or an infection. Stress and skin injury can trigger flares in people who already have it.

What is the best treatment for vitiligo on the face?

The face responds best to treatment. Dermatologists usually start with a topical calcineurin inhibitor such as tacrolimus, which is safe for long-term use on facial skin, or ruxolitinib cream, the first FDA-approved repigmentation treatment, for patients 12 and older. Narrowband UVB phototherapy is added for larger or stubborn areas. Combined treatment produces the fastest repigmentation.

How long does narrowband UVB take to work for vitiligo?

Visible repigmentation usually begins after two to three months of treatment two or three times a week, and a full course lasts six to twelve months or longer. Color often returns first as small dots around hair follicles that gradually merge. Phototherapy works best when combined with a topical treatment and is most effective on the face, neck, and trunk.

Is vitiligo linked to thyroid disease?

Yes. People with vitiligo have a higher rate of autoimmune thyroid disease, and a dermatologist will usually order thyroid blood tests at diagnosis and periodically afterward. Vitiligo is also associated, less commonly, with other autoimmune conditions such as alopecia areata, type 1 diabetes, and pernicious anemia.

Does vitiligo need sunscreen?

Yes, more than most skin. Vitiligo patches contain no melanin and can burn in minutes, and sunburn can trigger new patches. Apply a broad-spectrum SPF 30 or higher to exposed patches every day and reapply outdoors. Sunscreen on the surrounding normal skin also keeps it from tanning, which makes the contrast with the patches less noticeable.

Related reading: our sunscreen guide, psoriasis treatment (also treated with narrowband UVB), pediatric dermatology, and the patient education hub.