Medical Edge Newspaper Column

Condition That Causes Skin to Lose Its Color is Normally Not Reversible

September 11, 2009
Dear Mayo Clinic:
For the past 19 years my father has had vitiligo, and within the last two years had completely lost all pigmentation. However, about a month ago, some dark patches of pigmentation seem to have begun to appear in his cheeks and have now traveled to his ears. These patches seem to then fade into freckle-like spots. He was told it is not cancerous and that it is possible that the vitiligo was reversing itself. Is this possible?

Answer:
Vitiligo — a rare condition in which skin loses its pigment — often progresses slowly, as in your father's case. Although some people with vitiligo have areas on their bodies where color reappears (repigmentation), this is uncommon and very rarely signals reversal or remission of the disease.

In people who have vitiligo, the skin loses melanin, the pigment that determines skin, hair and eye color. Vitiligo occurs when the cells that produce melanin either die or stop making this pigment, causing slowly enlarging white patches of irregular shapes to appear on the skin.

Exactly what causes vitiligo is unclear. Some studies seem to indicate that vitiligo may be an autoimmune disorder. For some reason, a person's immune system attacks and destroys the pigment cells. Heredity may also play a role because, in some cases, vitiligo appears to run in families. In addition, some people have reported that a single event — such as a sunburn or emotional distress — seems to have triggered vitiligo.

The amount of pigment lost due to vitiligo can vary significantly from one person to another. Typically, the condition first appears as milky-white patches on the skin. Although any part of the body can be affected, depigmentation usually develops first on areas of the body frequently exposed to the sun — the hands, feet, arms, face and lips.

Vitiligo generally appears in one of three patterns: focal — depigmentation limited to one or a few areas of the body; segmental — the loss of skin color on one side of the body; or generalized — widespread pigment loss across many parts of the body, often symmetrically. The progression of vitiligo is difficult to predict. Sometimes the patches stop forming without treatment. Commonly employed treatments include the use of topical creams containing corticosteroids or vitamin D derivatives, often combined with the administration of specific types of ultraviolet light (phototherapy). But, in many cases, pigment loss spreads and in severe cases can eventually involve most or all of the skin surface.

For some, color may reappear without treatment in areas affected by the disease — a process known as spontaneous repigmentation. Usually, spontaneous repigmentation occurs on sun-exposed regions of the skin, such as the face or hands. In almost all cases, however, spontaneous repigmentation takes place only in isolated areas and results in uneven coloring, such as streaks or spots. Very rarely, spontaneous repigmentation is a sign that vitiligo is reversing itself or the disease is going into remission. Alternatively, in time, the areas of repigmentation may disappear.

Your father should continue to be very careful about protecting his skin, because a lack of melanin leaves skin particularly vulnerable to sun damage. The pigmentation he's experiencing could represent his skin's attempt to protect itself by forming irregular, freckled repigmentation. People who have vitiligo are at increased risk of skin cancer. To shield his skin from the sun's harmful rays, he should wear a sunscreen with an SPF of 30 or more that protects against both UVA and UVB light.

Researchers are investigating new ways to treat vitiligo. If your father is interested in learning about new treatments that may be available, I'd encourage him to talk with his doctor or a dermatologist experienced in treating people who have vitiligo.

— Lawrence Gibson, M.D., Dermatology, Mayo Clinic, Rochester, Minn.