Patient information · Dermatology
Vitiligo
treatable, and treated earlier works better
Vitiligo is loss of the pigment cells in the skin, producing well-defined pale patches. It is an autoimmune condition, not an infection, and it is not contagious. Treatment works best on patches that are recent and on the face and neck — which is the argument against a wait-and-see approach.
Arrange assessment promptly if you have
- rapidly spreading patches over weeks
- vitiligo with unexplained tiredness, weight change or palpitations — the thyroid needs checking
- patches that are itchy, red, scaly or raised, which suggests a different diagnosis
- loss of pigment inside the eye, or with hearing change
- significant distress or low mood about your appearance
Vitiligo is associated with other autoimmune conditions, most commonly autoimmune thyroid disease, which occurs in a significant minority and is easily missed. If you are struggling with the psychological impact, that is a legitimate reason to seek help — Samaritans are free on 116 123 at any hour.
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.
Treat early where you can
Repigmentation depends on pigment cells migrating in from hair follicles at the edges and base of the patch. Recent patches, and areas with plenty of hair follicles — the face and neck — respond far better than long-standing patches on the hands, feet, lips and fingertips, which have few follicles and respond poorly. Waiting to see what happens is understandable and it does cost you some of the treatment response.
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.
Why come to us. Vitiligo is frequently dismissed as cosmetic and left untreated, which forfeits the window when it responds best. Our dermatology team can confirm the diagnosis, prescribe topical treatments not available over the counter, arrange phototherapy through our CQC-registered partners, and check the associated autoimmune conditions with bloods taken in-house and explained the same visit. We can also refer for psychological support where appearance is affecting your confidence — which is not a minor part of this condition. No referral needed, seven days a week.
Dermatology assessment without a referral
Prescription treatment, autoimmune bloods in-house. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.