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Conditions We Treat

Vitiligo

At Livingstone Dermatology, we understand that your skin is a reflection of your health and well-being. We are committed to the latest advancements in dermatological science, and dedicated to providing you with quality care.

Vitiligo is a skin condition characterised by the loss of pigment of the skin. This condition affects about 1% of the population worldwide [1], and the psychological burden of vitiligo can negatively impact patients’ quality of life. Our experienced dermatologists offer expert care to help you understand and manage this condition effectively.

What is vitiligo?

Vitiligo is an autoimmune disease whereby the body’s immune system attacks melanocytes, the pigment-producing cells of the skin. The result of melanocyte destruction is patches of depigmented skin, which are lighter in colour. These patches can grow bigger over time, or stop progressing.

Vitiligo treatment in Singapore.
Vitiligo is characterised by the loss of pigment on skin, resulting in white or pale patches on the skin.

Common misconceptions about vitiligo

Common misconceptions and misunderstandings about the condition contribute to the stigma surrounding vitiligo. Some of these include:

  • Vitiligo is contagious – Vitiligo is an autoimmune condition and is not infectious or contagious.
  • Vitiligo only affects dark skinned people – Vitiligo can affect anyone of any ethnicity or skin colour. However, vitiligo may appear more apparent or obvious in people with dark skin, hence why the misconception persists.
  • Vitiligo can eventually turn your whole body white – There are many types of vitiligo, certain types of vitiligo may result in nearly all skin surfaces to lose pigment, other types of vitiligo may develop in patches all over the body. In some, the loss of pigment may appear as isolated patches.
  • Vitiligo is associated with skin cancer – Vitiligo is not associated with skin cancer. The condition has a different, or rather opposing, mechanism compared to skin cancer development. However, a certain type of treatment for vitiligo, psoralen UVA therapy, was associated with an increased risk of skin cancer. On the other hand, certain types of immunotherapy used in skin cancer treatments were also associated with an increased risk in vitiligo development.

What does vitiligo look like?

Vitiligo appears as a small patch of white or pale skin that may spread over time. Typically vitiligo appears as:

  • Patches of skin that are white, or paler than your skin colour
  • Patches of white or grey hair on the body
  • Patches of lost pigment in the mucous membrane, including the inside of the mouth and the genital mucosa

Other accompanying symptoms of vitiligo can also include:

  • Uveitis, inflammation of the pigmented layer of the iris, and swelling in the eye
  • Ear inflammation

Vitiligo may appear or develop in different patterns on the body, loss of pigment in vitiligo can take the following forms [2, 3]:

  • Non-segmental vitiligo – Non-segmental vitiligo is characterised by loss of pigment involving both sides of the body, with a tendency to show symmetrical distribution of depigmented macules. Non-segmental vitiligo can also include:
    • Generalised vitiligo – Generalised vitiligo often involves multiple parts of the body. The distribution of the loss of pigment often appears symmetrical.
    • Universal vitiligo – Universal vitiligo is characterised by a loss of pigment in nearly all of the skin’s surface.
    • Acrofacial vitiligo – Acrofacial vitiligo involves loss of pigment in the face, hands, and feet. Acrofacial vitiligo may eventually progress to be generalised vitiligo if other parts of the body start losing pigment.
  • Segmental vitiligo – Segmental vitiligo affects one side of the body, and typically has a younger age of onset. Depigmentation in segmental vitiligo occurs rapidly (between 6 – 24 months) and then stops, and is unlikely to progress any further.
  • Focal vitiligo – Focal vitiligo refers to isolated areas of depigmented skin.

Scientists believe that there may be genetic factors that contribute to the different patterns of vitiligo [2].

The exact mechanisms of vitiligo are not fully understood. It is believed that CD8+ T cells attack the melanocytes by producing the cytokine interferon-gamma (IFN-γ). IFN-γ release leads to increased T cell recruitment, causing a positive feedback loop that leads to gradual loss of melanocytes. The destroyed melanocytes also release antigens which are taken up by other immune cells. A special type of immune cells, referred to as memory T cells “remembers” the melanocyte antigens. Memory T cells contribute to the repeated attacks on melanocytes, inhibiting pigmentation of the skin and contributing to disease relapses [1, 2].

The disease is also associated with several factors including:

  • Genetics – Genetics play a significant role in the likelihood of vitiligo development. Having a first-degree relative with vitiligo increases the risk of developing vitiligo from 1% to 6% [1].
  • Autoimmune diseases – Vitiligo is also associated with other autoimmune disorders, such as type 1 diabetes mellitus, autoimmune thyroiditis, Addison’s disease, rheumatoid arthritis, systemic lupus erythematosus.
  • Environmental stressors – Environmental stressors can cause cell injuries in the skin and melanocytes. Examples of cell stressors include radical oxygen species (ROS) and chemical exposure, which can lead to formation of melanocyte antigens, inflammation and activation of the immune cells [1].
  • Cancer treatment – Treatment for melanoma using checkpoint inhibitor PD-L1 has been implicated to contribute to the development of vitiligo lesions [1, 2].

Generally, your dermatologist can diagnose vitiligo by visually inspecting the patches associated with the condition. Vitiligo diagnosis can be done in the dermatologist’s office with the following tests:

  • Physical examination – Typically, your dermatologist will ask you about your family history, followed by examination of the vitiligo lesions. Your dermatologist may use a tool called Wood’s lamp, which emits ultraviolet (UV) light on your skin. If the skin fluoresces upon exposure, it may indicate that the patch is a vitiligo lesion.
  • Blood tests – Blood tests are typically performed to diagnose other autoimmune diseases that you may have.
  • Eye examination – Your doctor may perform eye examinations to look for signs of uveitis. Uveitis sometimes occurs together with vitiligo.
  • Skin biopsy – A skin biopsy can be performed to examine the skin tissues or cells. Normally, a skin biopsy is not necessary for the diagnosis of vitiligo, it is typically used to rule out other causes of skin depigmentation or for a differential diagnosis of conditions that may resemble vitiligo.

You may choose to leave your vitiligo untreated, however the condition can be reversed with proper treatment if it causes significant distress. Common treatment options for vitiligo include:

  • Corticosteroids – Corticosteroid treatment for vitiligo can reduce inflammatory response involved in the pathophysiology of the disease. Corticosteroids work by reducing cytokine and chemokine levels in the body hence reducing T cell activity, hence controlling the disease’s progression. Corticosteroids are usually given as topical ointments or creams, with systemic treatment typically recommended for those with active/progressing disease. Common topical corticosteroids for vitiligo include betamethasone, clobetasol, hydrocortisone, and fluticasone. Systemic corticosteroids can include methylprednisolone and dexamethasone [4].
  • Calcineurin inhibitors – Calcineurin inhibitors such as tacrolimus and pimecrolimus block the activity of the enzyme calcineurin, hence reducing the production of cytokines such as IL-2, IFN-γ, and TNF-α [2]. This subsequently reduces T cell activity that destroys melanocytes.
  • Janus kinase (JAK) inhibitor – JAK inhibitors such as ruxolitinib work by inhibiting Janus kinase enzymes, hence interfering with the signals that lead to the production of cytokines and chemokines involved in vitiligo lesion formation, such as IFN-γ, IL-2, IL-15 [2]. JAK inhibitors can also be given as a topical treatment or a systemic treatment.
  • Immunosuppressants – The use of immunosuppressive medication such as methotrexate, cyclosporine, or azathioprine can sometimes be used in place of JAK inhibitors [2].
  • Psoralen plus UVA (PUVA) therapy – PUVA therapy involves taking a medication containing psoralen, followed by UVA light exposure which activates the psoralen into chemical compounds that suppresses the immune system while stimulating repigmentation via melanocyte proliferation and pigmentation [1].
  • Phototherapy – Narrow-band UVB (NB-UVB) phototherapy involves exposure to a narrow range of UVB wavelength via a lamp. Phototherapy using NB-UVB mainly functions to encourage repigmentation of vitiligo lesions by stimulating melanocyte migration and proliferation. NB-UVB phototherapy is also typically preferred as it is associated with lower risks of adverse effects [1, 2 , 4].

Treatment of vitiligo can be done on active or stable lesions. In some cases, these different treatment modules can be combined. However, it is important to note that vitiligo is a chronic condition, and relapses and recurrences of depigmentation may occur even after treatment.

There is no cure for vitiligo, it is a chronic autoimmune condition that can progress further or relapse. However, various treatment options are available to control the symptoms or halt disease progression and repigment the skin.

Partial view of young woman with vitiligo holding container with cosmetic cream in bedroom

Coping with vitiligo

The impact of vitiligo on your self-esteem cannot be ignored. Changes in your appearance and social stigma surrounding the condition are thought to contribute to poor self-esteem in vitiligo patients. A number of things can help with living with vitiligo:

  • Understanding your condition – Education and awareness helps with empowerment. Understanding vitiligo and how it works can help you to navigate your life with the condition. Knowledge on your triggers, symptoms, and treatment options can benefit you in controlling or treating the progression of the disease. Educating your loved ones and people around you can also benefit your self-esteem.
  • Reduce stress – Just like other autoimmune diseases, vitiligo can worsen with stress. Relieving or managing your stress levels and avoiding triggers can prevent disease progression.
  • Maintain a healthy lifestyle – Maintaining a healthy lifestyle such as being physically active and adopting a healthy diet can improve your overall well-being and mental state. Adopting a diet rich in anti-inflammatory foods such as fish rich in healthy fats, or fruits and vegetables high in vitamins and antioxidants, can reduce inflammatory triggers that contribute to autoimmune diseases like vitiligo.
  • Consider counselling – Keeping your mental health in check is equally important as keeping your body healthy. Consider counselling or psychotherapy to help with psychological effects of vitiligo such as anxiety and depression.

Summary

Although a typically benign condition, loss of skin pigment in vitiligo can cause psychological distress in patients. Our dermatologist understands the impact vitiligo can have on self-esteem and body image. We provide support and guidance on effectively managing vitiligo, including treatment recommendations.

Schedule an appointment with us today for a comprehensive skin analysis and personalised treatment plan.

Young half-naked woman with vitiligo posing on camera isolated over white background

Frequently Asked Questions

Can vitiligo go away?

Vitiligo is a chronic autoimmune condition, and is unlikely to go away on its own. In some cases, the patches can go away on their own, but there is no way of knowing whether the patches may go away or progress further. Treatment options are available to control skin depigmentation, as well as to repigment the depigmented lesions.

Vitiligo affects about 1% of the world’s population, people of any skin colour, race/ethnicity, or gender can develop vitiligo.

Vitiligo does not cause skin cancer. On the contrary, vitiligo was associated with a lower risk of skin cancers including melanoma and non-melanoma cancers. This is likely due to the overactive immune system in vitiligo, which may have a protective effect against melanoma [2]. However, vitiligo treatment using PUVA therapy is associated with an increased risk of skin cancers [1]. Hence, medical consultation is important in diagnosing the condition and choosing a suitable treatment according to your needs.

References

  1. Frisoli ML, Essien K, Harris JE. Vitiligo: Mechanisms of Pathogenesis and Treatment. Annu Rev Immunol. 2020 Apr 26;38:621-648. doi: 10.1146/annurev-immunol-100919-023531. Epub 2020 Feb 4. PMID: 32017656.
  2. Speeckaert R, Caelenberg EV, Belpaire A, Speeckaert MM, Geel NV. Vitiligo: From Pathogenesis to Treatment. J Clin Med. 2024 Sep 3;13(17):5225. doi: 10.3390/jcm13175225. PMID: 39274437; PMCID: PMC11396398.
  3. Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CC, Goh BK, Anbar T, Silva de Castro C, Lee AY, Parsad D, van Geel N, Le Poole IC, Oiso N, Benzekri L, Spritz R, Gauthier Y, Hann SK, Picardo M, Taieb A; Vitiligo Global Issue Consensus Conference Panelists. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2012 May;25(3):E1-13. doi: 10.1111/j.1755-148X.2012.00997.x. PMID: 22417114; PMCID: PMC3511780.
  4. Seneschal J, Boniface K. Vitiligo: Current Therapies and Future Treatments. Dermatol Pract Concept. 2023 Dec 1;13(4S2):e2023313S. doi: 10.5826/dpc.1304S2a313S. PMID: 38241396; PMCID: PMC10824325.

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