What are the signs of vitiligo?
People who develop vitiligo usually first notice white patches or spots (depigmentation) on their skin. The skin remains of normal texture, and there is usually no itching or other symptoms. These patches are more obvious in sun-exposed areas, including the hands, feet, arms, legs face, and lips. Other common areas for white patches to appear are the armpits and groin and around the mouth, eyes, nostrils, navel, and genitals. Vitiligo generally appears in one of three patterns. In one pattern (focal pattern), the depigmentation is limited to one or only a few areas. Some people develop depigmented patches on only one side of their bodies (segmental vitiligo). But for most people who have vitiligo, depigmentation occurs on different parts of the body (generalized vitiligo), often similar on each side of the body. In addition to white patches on the skin, some people with vitiligo may experience white hair growing in on the scalp, eyelashes, eyebrows, and beard. In extremely rare cases, vitiligo can affect eye color or the pigment of the retina.
Vitiligo generally appears in one of three patterns. In one pattern (focal pattern), the depigmentation is limited to one or only a few areas. Some people develop depigmented patches on only one side of their bodies (segmental pattern). But for most people who have vitiligo, depigmentation occurs on different parts of the body (generalized pattern). In addition to white patches on the skin, people with vitiligo may have premature graying of the scalp hair, eyelashes, eyebrows, and beard. People with dark skin may notice a loss of color inside their mouths.
Do the depigmented patches spread?
There is no way to predict if vitiligo will spread. For some people, the depigmented patches do not spread. However, the disorder is usually progressive, and over time the white patches often spread to other areas of the body.
For some people, vitiligo spreads slowly, over many years. For others, the diffusion occurs rapidly. Some people have reported additional depigmentation following periods of physical or emotional stress.
How is the diagnosis of vitiligo made?
Important factors in a patient's medical history include: vitiligo in the family; a rash, sunburn, or other skin trauma at the site of vitiligo 2 to 3 months before depigmentation started; stress or physical illness; and premature graying of the hair (before age 35). In addition, it is important to know whether the patient or anyone in the patient's family has had any autoimmune diseases and whether the patient is very sensitive to the sun.
The doctor then examines the patient to rule out other medical problems. The doctor may take a small sample (biopsy) of the affected skin and may also take a blood sample to check the blood-cell count and thyroid function. For some patients, the doctor may recommend an eye examination to check for uveitis (inflammation of the front portion of the eye). A special blood test to look for the presence of antinuclear antibodies (a type of autoantibody) may also be done. These evaluations can help to determine if the patient has an additional autoimmune disease.