Private vitiligo clinic in London, same-day dermatology.

What happens

The immune system destroys melanocytes, the cells that make pigment. The result is sharply defined milky-white patches, most often on the hands, face, around body openings, and in areas of friction or previous injury. Hair growing within a patch may also turn white. It affects around 1% of people worldwide and is equally common across all skin tones — though it is far more visible, and often far more distressing, on darker skin.

• Non-segmental vitiligo — the common form, usually symmetrical on both sides of the body, tending to progress in episodes over years.
• Segmental vitiligo — one area on one side, often appearing in childhood, progressing for a year or two and then stabilising. Less associated with other autoimmune disease.
• It is unpredictable: patches can remain static for years, spread, or occasionally repigment on their own.

Treatment

• Topical steroids — a potent preparation used in courses with breaks, effective particularly on the body and on newer patches.
• Topical calcineurin inhibitors — tacrolimus or pimecrolimus, preferred for the face, eyelids and skin folds where steroids thin the skin.
• Phototherapy — narrowband UVB, two or three times a week over several months, and the most effective treatment for widespread vitiligo.
• Newer topical treatments targeting the immune pathway are now becoming available for facial and non-segmental vitiligo.
• Surgical grafting for small, stable, segmental patches that have not changed for a year or more.
• Expect three to six months before judging any treatment, and repigmentation often begins as small dark dots within the patch rather than from the edges inward.

Sun protection and camouflage

• Patches have no protection at all and burn readily — use SPF 50, reapplied, and cover up. Burning also risks new patches through skin damage.
• Sunburn on surrounding skin increases contrast and makes patches more obvious.
• Medical camouflage is waterproof, lasts all day and is available on prescription. Changing Faces runs a free UK Skin Camouflage Service.
• Self-tanning products containing DHA colour vitiligo patches and can reduce contrast effectively.
• Do not use sunbeds, and avoid skin-lightening products entirely.

What else to check

Because vitiligo is autoimmune, it is worth checking thyroid function, and considering B12, ferritin, coeliac screening and diabetes where symptoms suggest. Autoimmune thyroid disease is by far the commonest association and often silent.