Ask the experts…vitiligo

Around 1% of the UK population lives with vitiligo, a skin condition that causes to the skin to lose pigmentation. It’s rare but it’s not that rare.

While it’s not harmful and in some quarters, has helped to make people’s careers (Canadian supermodel Winnie Harlow is famed for her patches), living with any skin condition can present difficulties.

That’s why we teamed up with the British Skin Foundation for a vitiligo-themed online expert clinic.

Our expert panel included consultant dermatologists Dr Anton Alexandroff, Dr Emma Wedgeworth, Dr Dev Shah and Dr Adil Sheraz, as well as Professor Andrew Thompson, registered clinical and registered health psychologist. Below are some the best questions and answers from the clinic:

I have noticed little white dots developing on my legs. It started with one or two but now I have more. Could this be vitiligo?

Dr Anton Alexandroff: This is likely to be guttate hypomelanosis. You can read more about this common skin condition on my website and of course it would be even better to see your dermatologist to check the diagnosis.

I had light therapy back when I was first diagnosed and I've also had the steroid creams but they didn't really help. Is there likely to ever be a cure?

Dr Emma Wedgeworth: We do still use light therapy (phototherapy) as one of our main treatments for vitiligo. If you had it many years ago, you may benefit from another course of treatment - so it might be worth checking with your doctor. We also routinely use alternatives to steroid creams - topical calcineurin inhibitors (Protopic or Elidel), particularly on facial vitiligo.

If the vitiligo is stable, surgical options might be open to you. Removing the top layer of affected skin and then moving skin from unaffected areas can be helpful.

There are also some really exciting progress being made in clinical trials. A new class of medicines known as JAK inhibitors has shown great promise in vitiligo - both as creams and tablets. Research is also getting to the bottom of the immune cause of vitiligo which will help us to find new ways to target the condition. Professor John Harris in the US is doing a lot of research on this, so check him out. Unfortunately no cure yet, but a log of progress.

I use factor 30 suncream but am concerned that my vitiligo makes me vulnerable to skin cancer. Is there anything else I can do to protect myself but ensure I still get my daily dose of vitamin D?

Dr Dev Shah: The research on vitiligo and skin cancer is interesting. Some research has shown that people with vitiligo are actually less prone to skin cancer! However, we recommend that you take a daily vitamin D supplement of at least 10iu or 400mcg and not rely on your sun exposure to get this. It’s important not to burn when in direct sunlight and to continue to use your sun protection when outside.

I have a small patch of vitiligo under my left knee which developed a year ago. Is there a way to tell if it will spread and how fast?

Dr Adil Sheraz: Vitiligo is an unpredictable condition and sometimes not much can be done to prevent it from spreading. However, early detection is important for a better outcome.

Some features to look out for include: confetti-like pigmentation, irregular borders to the vitiligo patch, itching and inflammation. These features can indicate active vitiligo and treating it at this stage will result in a better chance of re-pigmentation.

Sometimes, these features can be difficult to see but a Wood’s lamp can help with delineating borders. I'd advise seeing a dermatologist who can assess and treat sooner rather than later.

Why do I and my brother have it but our sister doesn’t? My brother and I are both type 1 diabetics. Could that be linked?

Dr Anton Alexandroff: The inheritance of the vitiligo is not completely understood and is thought to depend on a number of genes/factors. Vitiligo is more common in people with diabetes because both are autoimmune diseases. If one member of the family has vitiligo then another member has a higher chance of having vitiligo too.

I've have hyperthyroidism and have just started developing some white symmetrical white patches on my feet. The GP confirmed it was generalised vitiligo. Why is this happening?

Dr Dev Shah: There is a connection between thyroid issues and vitiligo and unfortunately there is no good reason why you should develop it at this age. Treating your hyperthyroidism does not usually improve the vitiligo or vice versa. If it is symmetrical and spreading, then early treatment is key to improving success. For your vitiligo, I recommend using a combination of potent topical steroids, a calcineurin inhibitor (an immune system suppressant), and light treatment.

My wife and I are thinking of starting a family. My wife has vitiligo and we've heard it could be hereditary. What is the likelihood of our children developing the condition?

Dr Adil Sheraz: Vitiligo is thought to be an autoimmune disease and as yet the exact cause has not been elucidated. The condition is thought to be multi-factorial, which means that it’s a combination of genetic factors and environmental triggers (which have not been identified as yet). It is thought that between 25% and 50% of patients with vitiligo will know a relative with the condition and around 6% will have a sibling with vitiligo. The risk of a child having the condition is around 5% - so just because one of you has vitiligo, that by no means guarantees that your children will have it too.

I've found that the Veil camouflage creams all tend to be the wrong colour - I struggle to find a match as I am very olive-skinned. What should I do?

Dr Emma Wedgeworth: I would suggest you book another appointment with a camouflage expert through Changing Faces and discuss which products are best.

You can read more about the British Skin Foundation clinic on Vitiligo here. Thank you to our experts who so kindly gave their time to answer questions.

Information contained in this Articles page has been written by talkhealth based on available medical evidence. The content however should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands or treatments.

Information written by the talkhealth team

Last revised: 10 July 2020
Next review: 10 July 2023