Vitiligo

Vitiligo is a skin condition that causes the loss of pigment in patches across the skin. These patches tend to start small and grow over time. What’s happening beneath the surface is this: melanocytes, the cells responsible for producing skin pigment (melanin), stop functioning or die off. Without those cells, the skin in those areas loses its color.

Vitiligo affects people of all skin tones, but it’s often more noticeable in individuals with deeper complexions. While it doesn’t cause pain or physical discomfort, the visible changes can understandably affect a person’s confidence and emotional well-being.

We still don’t have a complete picture of why vitiligo develops, but most research points to it being an autoimmune condition. That means the body’s own immune system mistakenly attacks the melanocytes in the skin.

Some potential contributing factors and triggers include:

• Genetics (vitiligo can run in families), but there are a number of genes involved
• Autoimmune disorders, like thyroid disease
• Physical or emotional stress
• Skin trauma, like a cut or severe sunburn (this is called the Koebner phenomenon)

Vitiligo usually begins with one or two small patches of lighter skin. Over time, more patches may appear, and they may spread or stay the same for years. The most commonly affected areas include:

• Hands and fingers
• Face (especially around the mouth and eyes)
• Feet
• Elbows and knees
• Armpits and groin
• Around body openings (mouth, eyes, nose, genitals)

There are different subtypes of vitiligo based on how and where it appears:

• Non-segmental vitiligo is the most common type, with symmetrical patches on both sides of the body
• Segmental vitiligo, also called unilateral vitiligo, is usually limited to one side of the body and is more stable over time
• Universal vitiligo affects most of the body (rare)

Some people also experience white or graying hair on the scalp, eyebrows, eyelashes, or beard due to pigment loss in the follicles.

Treatment for Vitiligo at Cascade Eye & Skin Centers
There is currently no cure for vitiligo, but there are effective treatments that can help restore pigment, stop the spread of depigmentation, and improve the overall appearance of the skin. Treatment recommendations are based on how widespread the condition is, how long it’s been present, and how it’s affecting your quality of life.

Topical Medications
These are often the first line of treatment and work best on smaller, more recent patches of vitiligo:

• Corticosteroids: Help reduce inflammation and may stimulate re-pigmentation.
• Vitamin D Derivatives: Help modulate the immune response in the skin and may be used alongside steroids.
• Calcineurin Inhibitors: Particularly effective on thinner-skinned areas like the face, these reduce immune system activity in a targeted way.

Oral Medications
In some cases, systemic medications may be used to help regulate immune response or manage more widespread disease. This is less common but may be appropriate for progressive or extensive vitiligo.

UVB Phototherapy (Light Therapy)
This is one of the most effective treatments for vitiligo, especially when used in combination with topical medications. Narrowband UVB phototherapy works by slowing the immune attack on melanocytes and stimulating remaining pigment cells to regenerate.

Treatment typically involves two to three sessions per week over the course of several months. Some patients begin to see improvement after 8–12 weeks, with continued progress over time.

Vitiligo is highly individual. Some patients respond very well to treatment, while others see more gradual or limited improvement. Results may include:

• Repigmentation of affected areas
• Stabilization of pigment loss (no new patches forming)
• Improved skin tone balance over time

That said, it’s important to have realistic expectations. Treatment is often about managing and minimizing the condition, not making it disappear completely. Our team will walk you through what’s possible for your skin and help you track progress along the way.

If you’re seeing new pigmentation (or haven’t had a skin exam this year), a full-body skin exam is always a good place to start. We’ll examine your skin thoroughly to rule out any suspicious lesions, identify signs of long-term sun damage, and help you create a care plan that balances both aesthetic goals and long-term skin health.