Vitiligo: Initial Stage, How It Begins and First Symptoms

A light patch on the skin almost always causes alarm: it seems as though the pigment is gone forever. Vitiligo is indeed associated with persistent loss of melanin, but it begins gradually and does not always mean extensive involvement. Let us explain without myths what the initial stage looks like and what confirms the diagnosis.

What vitiligo is

Vitiligo is a long-term condition in which pale white patches appear on the skin due to a lack of melanin, the skin pigment. Melanin is produced by cells called melanocytes; in vitiligo there are not enough functioning melanocytes to provide normal skin or hair color. It occurs in different populations in 0.1% to 2% of the population and more, and more often manifests in people aged 10 to 30 years. Vitiligo is not contagious.

How vitiligo begins: first signs

Most often the disease starts with a single pale patch on unchanged skin, which gradually becomes completely white. The center of the patch may be white, while the skin at the edge is lighter than usual. If blood vessels are visible under the skin, the patch looks slightly pink rather than white. The edges may be smooth or irregular, sometimes red and inflamed or with brownish darkening. The skin in the lesions does not dry out and does not hurt, but the patches sometimes itch. Hair on the affected area may turn gray or white.

Initial stage of vitiligo: where patches appear

Involvement is possible on any area of the skin, but more often affects the face, neck, hands, skin folds, fingers and wrists, armpits, groin, genitalia, skin around the mouth and eyes, and the inner surface of the mouth. Lesions also occur where there are hair roots, for example on the scalp. Non-segmental vitiligo is distinguished separately — symmetrical patches on both sides of the body, the most common type, about 9 out of 10 cases. The segmental form affects one area of the body and is more common in children.

Main symptoms of vitiligo

The key sign is depigmented areas of skin of varying size and shape that gradually grow and may merge into extensive zones. Severity is individual: some people have a few small patches, others have large merged areas, and it is impossible to predict the scale. White areas lack the protection of pigment and burn quickly in the sun, up to the point of blisters. In people with dark skin, color inside the mouth may be lost, and hair turns gray prematurely. Individual patches sometimes disappear on their own.

• A pale or white patch with distinct or irregular edges
• Symmetrical lesions on the hands, elbows, knees, feet
• Depigmentation of hair on the affected area
• Increased sensitivity of white areas to the sun

Causes of vitiligo according to medical data

The nature of the disease has not been fully studied. The non-segmental form is considered autoimmune: the immune system destroys melanocytes. The risk is higher with a family history of vitiligo or other autoimmune diseases, with a personal autoimmune disease, melanoma or non-Hodgkin lymphoma, and with certain changes in genes. The segmental form is linked to chemicals from nerve endings in the skin that are toxic to melanocytes. Possible triggers include stress, skin damage (Koebner phenomenon), hormonal changes, liver or kidney problems, and contact with certain chemicals.

How vitiligo is diagnosed

The diagnosis is made by a doctor after examining the affected areas. The doctor clarifies the family history of vitiligo and autoimmune diseases, whether there have been injuries or sunburns, how the skin reacts to the sun, and whether the patches change. When available, a Wood's lamp is used: in a dark room it is held 10–13 cm from the skin, and under ultraviolet light the lesions are seen better — this helps distinguish vitiligo from other conditions, such as tinea versicolor. Since the non-segmental form is associated with autoimmune diseases, the doctor assesses symptoms that may indicate Addison's disease or diabetes and may order a blood test to check thyroid function.

Vitiligo by itself is not a reason to call an ambulance; 103/112 — for life-threatening conditions, for example signs of stroke or heart attack, or severe injury.

This material is for reference purposes and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer