Vitiligo Symptoms and Diagnosis

The main symptom of vitiligo is the appearance of white patches on the skin, usually in areas where the skin is commonly exposed to the sun. The white skin spots can appear suddenly or gradually on the hands, feet, face, lips, and arms, along with other areas such as in the armpits and the groin, the navel, genitals, rectal region, and inside the nostrils. Those with darker skin may find that the inside of their mouth also loses pigmentation, and the white patches are often more apparent in those with naturally darker skin. The skin continues to feel normal and there is usually a darker border around the area of skin discoloration. The white patches are usually irregular and both sides of the body are equally affected, which may help identify other causes of depigmentation should a distinctive pattern emerge. There are three common patterns of vitiligo seen in patients:

Focal Pattern: where there are a limited number of areas affected by the white skin patches

Segmental Pattern: where the white skin spots develop on just one side of the body

Generalised Pattern: where depigmentation occurs across the body in a symmetrical fashion (this is the most common type of vitiligo seen).

Vitiligo progression may be slow in some cases and quite rapid in others, with a number of patients finding that the white patches of skin do not grow or spread at all after they first arise. Anecdotal evidence suggests that stress, both physical and emotional can contribute to vitiligo symptoms and is connected to a more rapid spreading of the white skin spots. Once the depigmentation occurs however, it is very difficult, and in some cases considered impossible, to reverse. Determining if the whitening of the skin is vitiligo-related means that a physician will ask questions about a patient’s recent history, such as whether they have experienced sunburn, skin trauma, emotional stress, or physical illness in the two or three months prior to the development of the skin condition.

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Enquiries about other family members’ health will also make up part of the diagnostic procedure as vitiligo is thought to be hereditary in many, if not all, cases. Where other family members, or the patient themselves, have autoimmune diseases there may be a higher degree of suspicion for vitiligo. Patients with grey hair will usually be asked when their hair lost pigmentation as another common symptom of vitiligo is an early greying of the hair, usually before the age of thirty-five or forty. This greying may affect the scalp hair alone but can also cause the eyelashes, eyebrows, beard, and other body hair to lose pigmentation..

Following the taking of a medical history, the doctor may collect a blood sample and take a small sample of skin (a skin biopsy) for laboratory testing. Examining the skin under a microscope may reveal a complete absence of melanocytes (the skin cells that produce pigment) which would confirm a diagnosis of vitiligo. Should there be signs of inflammation in the skin cells however, this may suggest to the physician that the hypopigmentation is connected to a different condition which may respond to alternative treatment. The kind of tests carried out will be determined by each individual’s circumstances but may include hormonal tests to check thyroid function as hyperthyroidism is linked to vitiligo. Those with Addison’s disease are also more likely to develop the skin disorder than the general population and tests for adrenal function may be carried out. Patients with pernicious anaemia also have a higher rate of vitiligo, and the physician may order tests for vitamin B12 levels to rule this out as a cause of vitiligo.

Where available, a physician or dermatologist may use a Wood’s light to check the skin. This handheld device emits ultraviolet light which causes depigmented areas of skin to glow bright white. Some patients may also have an eye examination carried out to check for uveitis, an inflammatory disorder in the eye which can co-exist with vitiligo. Blood tests for antinuclear antibodies may also be run to investigate the possibility of autoimmune disease in the patient with treatment for vitiligo dependent on the results of all such tests.

Vitiligo picture courtesy of James Heilman, MD.

Continue Reading –> Vitiligo Treatment

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