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    Mayo Clinic Q and A: Understanding vitiligo

a young woman with vitiligo affecting her face and arms, sitting in an outdoor cafe drinking iced coffeeDEAR MAYO CLINIC: I am in my mid-30s and have many small patches on my lower legs, ankles and arms that are much lighter in color than my skin. These patches don’t tan or change color. Is this vitiligo? If so, will these areas increase in size over time? Is there anything I can do for this condition?

 ANSWER: It is possible that the condition you describe could be vitiligo. However, there are many other conditions that can lead to lightening of the skin, too. To find out what’s causing your symptoms, you should see a dermatologist to evaluate the condition. If it is vitiligo, it can spread over time. Although vitiligo can be difficult to treat, there are therapies that may help.

Vitiligo is a rare condition in which the skin loses melanin, the pigment that determines skin, hair and eye color. Vitiligo occurs when the cells that produce melanin die or no longer form melanin, causing slowly enlarging white patches to appear on the skin.

It’s unclear exactly what causes vitiligo. It may be an autoimmune disorder, in which a person’s immune system attacks and destroys the pigment cells. Heredity also may play a role because, in some cases, vitiligo appears to run in families. In addition, some people have reported that a single event, such as a sunburn or emotional distress, seems to have triggered the vitiligo.

The amount of pigment lost due to vitiligo can vary significantly from one person to another. Typically, vitiligo first appears as milky-white patches on the skin. Although any part of the body may be affected, depigmentation usually develops first on sun-exposed areas, such as the hands, feet, arms, face and lips.

The progression of vitiligo is difficult to predict. Sometimes, the patches stop forming without treatment. However, pigment loss can spread. Eventually, it may involve most of the skin’s surface.

Diagnosis usually is made during a physical exam that includes using a special lamp to shine ultraviolet (UV) light onto the skin. Your dermatologist also will examine your skin to rule out other possible disorders. Taking a biopsy of a small sample of the skin that’s affected and performing blood tests to check for other underlying medical conditions may be part of your evaluation, too.

Effectively treating vitiligo can be a challenge, but therapies are available that may restore some skin tone. Creams that control inflammation, such as a corticosteroid cream, may return color to your skin. This is most effective when vitiligo is still in its early stages.

Because the immune system may play a role in its development, medications that affect the immune system are sometimes used to treat vitiligo. For example, ointments that contain medications known as calcineurin inhibitors, such as tacrolimus or pimecrolimus, may be useful for people with small areas of depigmentation, especially on the face and neck.

In addition to topical medications, UV light therapy may help to return color to areas of skin affected by vitiligo. Those treatments typically need to be repeated frequently for up to a year to have the most benefit.

At this point, however, your first step should be to make an appointment with a dermatologist. He or she can do a thorough assessment of your condition to determine what’s causing your symptoms and, based on that, recommend how best to move forward with treatment. — Dr. Matthew Hall, Dermatology, Mayo Clinic, Jacksonville, Florida