Vitiligo is a common disfiguring skin disease characterized by depigmented patches affecting approximately 1 percent of the general population. It is estimated that 2–3 million individuals have vitiligo in the United States. Although vitiligo can start at any age, about half develop it before the age of 20, and about 95 percent before age 40. It affects both sexes equally as well as all races and ethnicities.
Vitiligo is characterized clinically by very light colored macules, or "spots," and microscopically by the absence of melanocytes (skin cells that produce pigment or color) in the skin.
Affected areas are prone to sunburns and psychological effects can be severe, leading to depression and even suicide. It is particularly devastating in patients with darker skin, often those from minority groups, who suffer disproportionate psychological effects of the disease. Unfortunately, vitiligo often presents in childhood or adolescence, a time when physical appearance has an enormous effect on self-esteem.
Vitiligo can appear in several different patterns on the skin. These patterns have been classified into different categories as follows:
Generalized vitiligo is the most common form of vitiligo. Lesions are usually symmetrical, on both sides of the body. Common locations include the hands, wrists, elbows, underarms, eyelids, nostrils, lips, ears, hips, knees, ankles, and feet. Early on, lesions may be localized to just a few areas. This form of vitiligo usually progresses. The rate of progression can be very slow or fast. Research is underway to find a way to predict prognosis in patients with generalized vitiligo.
Segmental vitiligo appears as one or more areas of depigmentation on only one side of the body. Lesions can occur on the face, neck, trunk arms, or legs. These lesions often present in childhood and usually stabilize in a few years.
Universal vitiligo is a severe form of vitiligo in which more than 80 percent of the body loses pigment. This is the least common form of vitiligo.
Lip-tip vitiligo is an unusual form of vitiligo which only occurs on the lips, fingers, and toes.
Focal vitiligo is an uncommon form of vitiligo in which just one or a few isolated lesions appear on the skin in no consistent pattern. Sometimes focal vitiligo is an early form of generalized vitiligo in which the lesions have not yet spread throughout the body. Focal vitiligo is usually easier to treat than generalized vitiligo.