If you’ve heard of fashion model Winnie Harlow, you may already be familiar with a skin condition that affects between 0.5 and 1% of the population worldwide.
It happens when skin loses its pigment (coloring), causing white patches of skin that can sometimes cover the entire body. While Harlow has found stardom, that is not the reality for the vast majority of people with vitiligo.
“Many, if not most, people with vitiligo feel self-conscious,” says Brett King, MD, PhD, a Yale Medicine dermatologist. “Feelings range from embarrassment to clinical depression.”
“When vitiligo is very noticeable, patients often report that people will avoid touching them, even in day-to-day transactions such as when shaking hands or exchanging money at a restaurant,” says Dr. King.
Although there is no cure for vitiligo, there may be hope. At Yale Medicine Dermatology, Dr. King is performing research on the use of a new class of medicines for the treatment of the disorder.
What is vitiligo?
Vitiligo is a disease that causes patches of skin to lose their color, resulting in white spots. In some instances, most (or all) of the skin becomes white.
Skin, hair and eye coloring comes from a pigment called melanin. It’s related to an amino acid and is produced by melanocytes, the skin’s pigment-making cells, located in the epidermis (outer layer of skin). People with darker skin tones have more melanin in their skin than people who are fair.
Vitiligo occurs when the melanocytes are attacked (and destroyed) by the body’s immune system. “When pigment-making cells in the skin are destroyed, people develop white splotches, leading to psychological and social distress,” says Dr. King.
What parts of the body are susceptible to vitiligo?
It can occur anywhere on the body. Most commonly vitiligo affects the skin around the eyes, mouth, elbows, wrists, hands and ankles. The condition can sometimes involve large areas of skin, but it is rare for people to lose all of their skin pigment.
Who does vitiligo affect?
Vitiligo can affect anyone, but it is more noticeable in people with darker skin. About half of people with vitiligo develop it before age 20.
What are the causes of vitiligo?
Vitiligo is an autoimmune disease, and what determines whether or not a person develops the condition is a combination of genetic and other factors. "People who have vitiligo may also have other immune disorders like psoriasis, alopecia areata, and thyroid disease. Some people report developing vitiligo after physical injury or psychological distress, but it is not clear that such events cause vitiligo," Dr. King says.
How is vitiligo diagnosed?
If you have skin color changes, make an appointment with your dermatologist or primary care doctor who will gather your medical history and visually examine your skin. Sometimes a skin biopsy is necessary to make a diagnosis of vitiligo.
How can vitiligo be treated?
Vitiligo does not cause harm to the body. Treatments, which vary in effectiveness, are usually designed to restore color to the affected patches of skin. Below are some therapies dermatologists may use to treat patients with vitiligo:
- Light therapy: Also called phototherapy, depigmented areas of skin are exposed to special wavelengths of light, usually narrow band ultraviolet B, which helps repigment the skin.Treatment two to three times weekly for up to a year may be necessary before significant, though often incomplete, repigmentation occurs.
- Topical therapy: Topical steroids and topical calcineurin inhibitors are sometimes effective to restore pigment when small areas of skin are affected by vitiligo. However, in the case of topical steroids, there is risk that the skin will atrophy or sag, thin or develop stretch marks when used for too long. More recently, dermatologists have begun to use a topical Janus kinase (JAK) inhibitor to treat the underlying inflammation in order to help restore pigmentation as well (see below).
- Bleaching treatments: When treatment to achieve repigmentation is unsuccessful, sometimes patients with vitiligo decide to remove or depigment existing skin pigment so that their white patches blend together and are less noticeable. The only FDA-approved therapy for the treatment of vitiligo is a depigmenting agent called monobenzone. “We sometimes use this for depigmenting small areas of skin that cause people concern such as their face,” says Dr. King.
Again, success is variable with all of these treatments. Usually, many months of treatment are required before doctors begin to understand what kind of result is going to be achieved. And, even when good results are seen, continued treatment may be necessary in order to prevent disease relapse.
What makes Yale Medicine’s approach to treating vitiligo unique?
Our doctors are leading experts in dermatology, conducting research on hard-to-treat skin disorders such as vitiligo. It’s through academic medical research that new treatments become possible for people who otherwise have few options.
For example, Dr. King has pioneered the use of a class of medicines called JAK inhibitors for treatment of the disorder. He showed that a medicine originally intended for rheumatoid arthritis can restore normal skin pigment for patients with vitiligo. In vitiligo, the drug can work to calm the immune system so that it does not attack melanocytes. In 2022, the FDA approved a topical JAK inhibitor (ruxolitinib cream) for the treatment of vitiligo in both adult and pediatric patients (down to age 12 years). This represents the first FDA-approved treatment for vitiligo, and is part of the complement of vitiligo therapies offered by Yale Medicine dermatologists.