Young woman with VitiligoSharni Kaur, right, and her mother, Roop Singh. Sharni has suffered from vitiligo, which causes her skin to lighten, since she was nine years old.Singer/songwriter Michael Jackson suffers from vitiligo (see upper-arm)
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Vitiligo (IPA /ˌvɪtəˈlaɪgo/) or leukoderma is the patchy loss of skin pigmentation due to an auto-immune attack by the body's own immune system on skin melanocytes. It frequently begins in late adulthood, with patches of unpigmented skin appearing on extremities. The patches may grow or remain constant in size. Occasional small areas may repigment as they are recolonised by melanocytes. The population incidence is between 1% and 2%. more...

VACTERL association
Van der Woude syndrome
Van Goethem syndrome
Varicella Zoster
Variegate porphyria
Vasovagal syncope
VATER association
Velocardiofacial syndrome
Ventricular septal defect
Viral hemorrhagic fever
Vitamin B12 Deficiency
VLCAD deficiency
Von Gierke disease
Von Hippel-Lindau disease
Von Recklinghausen disease
Von Willebrand disease

Vitiligo is not contagious.

In some cases, mild trauma to an area of skin seems to cause new patches - for example around the ankles (caused by friction with shoes or sneakers). Vitiligo may also be caused by stress that affects the immune system, leading the body to react and start eliminating skin pigment.

The disease is not medically a problem, but it is mentally and socially to some people, other than the problem that the affected skin areas have no protection against sunlight - they burn but never tan. However, if the skin is naturally dark, the visual effect of the white patches may be considered disfiguring by some. (If the affected person is pale-skinned, the patches can be at least be made less visible by avoiding sunlight and the tanning of unaffected skin.) The location of vitiligo affected skin changes over time, with some patches re-pigmenting and others becoming affected. (Exposure to sunlight is always better; it helps the melanocytes regenerate to allow the pigmentation to come back to its original color.)

Vitiligo on the scalp may affect the colour of the hair (though not always), leaving white patches or streaks. It will similarly affect whiskers and body hair.

In some cultures there is a stigma attached to having vitiligo. Those affected with the condition are sometimes thought to be evil or diseased and are sometimes shunned by others in the community. People with vitiligo may feel depressed because of this stigma or because the way their skin looks is a dramatic change.


Steroids have been used to remove the white patches, but they are not very effective. Other more dramatic treatments include chemically treating the patient to remove all pigment from the skin to present a uniform skin tone. Current experimental treatments include exposure to narrow-band UV light, which seems to blur the edges of patches, and lightly freckling the affected areas. Immunomodulator creams are believed to cause repigmentation in some cases, but there is no scientific study yet to back this claim. All these treatments alter the appearance but do not address the underlying cause of vitiligo.

In late October of 2004, doctors successfully transplanted melanocytes to vitiligo affected areas, effectively repigmenting the region. The procedure involved taking a thin layer of normally pigmented skin from the patient's "gluteal region". Melanocytes were then separated out and used to make a cellular suspension. The area to be treated was then ablated with a laser, and the melanocyte graft applied. Three weeks later, the area was exposed to UV light repeatedly for two months. Between 73 and 84 percent of patients experienced nearly complete repigmentation of their skin. The longevity of the repigmentation differed from patient to patient.


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Narrow B and ultraviolet B radiation therapy for recalcitrant vitiligo in Asians - Washington Whispers
From Journal of Drugs in Dermatology, 12/1/03

Natta R, Somsak T, Wisuttida T, Laor L. J Am Acad Dermatol 2003 Sep: 49(3):473-6

The authors' objective was to assess the efficacy of NB-UVB in patients with vitiligo who did not respond either to topical therapy or to oral psoralen plus ultraviolet A (PUVA). This was a retrospective analysis of patients with vitiligo who were treated with NB-UVB from February 1998 to January 2001. They received NB-UVB treatment 2 times per week. The dose was increased by 10% to 20% per treatment for 20 treatments. The dose was then increased by 2% to 5% per treatment until 50% repigmentation was observed or persistent erythema developed. The treatment was considered a failure and terminated if the patient showed less than 25% improvement after 40 to 50 exposures, The cohort included 60 patients: 22 men and 38 women, aged 11 to 61 years, with localized-generalized vitiligo. All cases had been previously treated with topical steroid with or without topical psoralen with solar light exposure. The authors concluded that NB-UVB treatment in 25 of 60 patients (42%) achieved more than 50% repigmentation on face, trunk, arms, and legs. The hand and foot lesions showed less than 25% repigmentation in all cases and there was no significant difference between the responders and non-responders in age, sex, duration of diseases, and skin type. The response rate of patients who had not been previously treated with PUVA was significantly higher than that of patients who had been previously treated with PUVA (67% vs. 36%). This study demonstrates that NB-UVB is effective in repigmentation of vitiligo patients, and patients previously treated with PUVA are less responsive than those who have not had PUVA. The face, trunk, and proximal extremities were repigmented more than other sites of the body.


Current treatment modalities for vitiligo include PUVA therapy, narrow-band UVB therapy, topical corticosteroids, depigmentation therapy with monobenzylether of hydroquinone, and surgical treatments (minigrafting, thin split-thickness grafting, suction blister grafting, micropigmentation). The use of lasers, vitamin D analogues, tacrolimus, depigmentation with Q-switched ruby laser, and grafting of cultured melanocytes are newer techniques that offer promising results. More interesting is the use of NB UVB with tacrolimus or vitamin D analogues, yet repigmentation is reached more on the face, trunk, and proximal extremities. These are the same sites as with NB-UVB alone, but it seems that the addition of topicals to NB-UVB shortens the time to repigmentation. In my experience, steroids work better on proximal extremities than tacrolimus does. At the moment the NYU department of dermatology is conducting a double-blinded randomized study of Elidel[R] (Pimecrolimus cream 1%, Novartis Pharmaceuticals Corp.) vs. calcipotriol. The purpose is to evaluate steroid-sparing therapies for vitiligo; preliminary results are promising with both cohorts. In conclusion, many therapies exist for the treatment of vitiligo, but topicals in addition to NB-UVB are promising and seem to be better than either alone.

COPYRIGHT 2003 Journal of Drugs in Dermatology
COPYRIGHT 2004 Gale Group

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