Medical Encyclopaedia › Vitiligo (short definition)
In brief: Vitiligo is a chronic skin disease in which pigment-producing cells (melanocytes) are lost. This creates sharply demarcated, milky-white patches. The disease is neither contagious nor painful but can be a considerable burden for those affected, both in everyday life and emotionally. Vitiligo can be treated; however, there is as yet no reliable cure.
How does vitiligo develop?
In the most common form, the immune system attacks the body’s own melanocytes; vitiligo is therefore counted among the autoimmune diseases. A hereditary predisposition plays a role, as do oxidative stress in the pigment cells and immune messengers such as interferon-gamma, whose signals are relayed via so-called Janus kinases (JAK) – this is where the newer JAK inhibitors act. Triggers of a flare can be skin injuries, sunburn or severe stress. New patches at sites of friction or injury are known as the Koebner phenomenon. People with vitiligo more often have other autoimmune diseases, especially of the thyroid, such as Hashimoto’s thyroiditis.
Forms and course
- Non-segmental vitiligo: the most common form, usually on both sides and often symmetrical, preferentially on the face, hands, feet, joints and body openings. The course is difficult to predict, with phases of spread and standstill.
- Segmental vitiligo: limited to one side of the body or one skin area, often begins in childhood, usually spreads rapidly and then comes to a standstill.
- Mixed forms of both types as well as rare special forms.
Hair in the patches can also turn white; this is considered an unfavourable sign for repigmentation.
Diagnosis
The diagnosis is usually made on the basis of the typical appearance. Under Wood’s light (UVA lamp), the patches light up brightly, which also makes small lesions visible on fair skin. Other light patches, for example after inflammation or in fungal infections such as pityriasis versicolor, must be distinguished; rarely, a cutaneous lymphoma also has to be ruled out. Thyroid values and antibodies are often measured.
Treatment
The goals are to stop the spread and achieve repigmentation. Which treatment is suitable depends on the form, extent and activity of the disease and on the wishes of those affected. Treatment requires patience; first results usually only appear after months.
- Creams and ointments: corticosteroids or calcineurin inhibitors such as tacrolimus and pimecrolimus, the latter especially on the face. Since 2023, a cream containing the JAK inhibitor ruxolitinib has been approved in the EU for non-segmental vitiligo with facial involvement from the age of 12.
- Phototherapy: narrowband UVB (311 nm) for larger areas, and targeted treatment with the excimer laser; often combined with creams.
- In rapid spread, short-term oral corticosteroid pulse therapy may be considered.
- Surgical procedures such as the transfer of melanocytes from healthy skin may be considered for stable, especially segmental, vitiligo.
The face and neck usually respond better than the hands and feet. Relapses are possible after treatment is stopped. Further oral JAK inhibitors are being tested in studies.
Everyday life, sun protection and camouflage
Depigmented skin has no UV protection of its own and burns easily; a high sun protection factor and clothing are important. Sunburn can also trigger new patches; friction, tight clothing and injuries should likewise be avoided where possible. Special cover-up products (camouflage) or self-tanners can conceal the patches. In the case of great emotional distress, self-help groups and psychological support help. Very extensive vitiligo can in individual cases also be permanently depigmented; this is a far-reaching decision that should be discussed thoroughly. Whether the health insurer covers individual therapies should be clarified case by case.
Related terms in the encyclopaedia
Vitiligo, Melanocytes, Autoimmune disease, Koebner phenomenon, Wood’s light, Excimer laser, Ruxolitinib, Tacrolimus, Hashimoto’s thyroiditis, Melanin, Pityriasis versicolor
Sources
- Böhm M et al.: S1-Leitlinie Diagnostik und Therapie der Vitiligo. J Dtsch Dermatol Ges 2022
- Taieb A et al.: Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol 2013
- Europäische Arzneimittel-Agentur (EMA): Europäischer Öffentlicher Beurteilungsbericht (EPAR) zur Ruxolitinib-Creme bei nicht-segmentaler Vitiligo
- Ezzedine K et al.: Vitiligo. Lancet 2015
- Ezzedine K et al.: Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012
- Bergqvist C, Ezzedine K: Vitiligo: A Review. Dermatology 2020
Note: This article is for general information and does not replace advice, diagnosis or treatment from a doctor, dentist or pharmacist. Last updated: October 2026.