What You Need to Know About the Science of Vitiligo

This post is sponsored by Incyte.

What’s really happening within the skin of a person living with vitiligo? The answer matters—because your health matters. Understanding the science of vitiligo can help you manage it effectively as an autoimmune condition. 

That’s why we sat down with Dr. Adnan Nasir, Senior Medical Director, US Medical Affairs at Incyte and a dermatologist, to learn about the complexity of this condition, including what’s happening within the skin during the depigmentation and repigmentation processes, and the time it takes.

Here are our top takeaways from our conversation—and what you need to know about vitiligo. (Spoiler alert: Yes, you should be managing your vitiligo in partnership with a dermatologist on a regular basis, even if treatment is not your goal.)

Takeaway #1: Vitiligo is an autoimmune condition that can impact your overall health

Vitiligo is a chronic, immune-mediated condition characterized by depigmentation of the skin, resulting in white patches on the face and body that can progress over time. As you may know, vitiligo manifests most prominently on the skin; however, vitiligo is more than cosmetic, and it can have a profound impact on those living with it.

To better understand vitiligo, we must also understand the immune system. In vitiligo, the immune system attacks the body’s melanocytes: the pigment-producing cells responsible for skin and hair color. When the melanocytes are destroyed, the pigment in certain areas of the skin begins to disappear, resulting in the visible white patches that represent loss of pigment.

Additionally, because vitiligo is an autoimmune condition, those living with vitiligo have a greater risk of developing other autoimmune conditions such as thyroid disease, rheumatoid arthritis and inflammatory bowel disease. As a result, for people living with vitiligo, it’s important to not only pay attention to your skin, but to your overall health.

Takeaway #2: The depigmentation and repigmentation processes are complex

The processes of depigmentation and repigmentation are complex, can take time, and vary greatly from person to person—making individual experiences unpredictable. Each person’s immune system is different, which makes the depigmentation and repigmentation processes just as unique.

“It’s different for everybody,” said Dr. Nasir about the rate of depigmentation in vitiligo. “There are people who can have sudden, widespread loss of pigment. There are people who can have very gradual loss of pigment over many, many decades. And then there are people who fall in-between, where they have periods of pigment loss, and periods where their vitiligo is dormant.” This can be true for the repigmentation process as well. 

Additionally, many factors contribute to the rate of depigmentation including thermal, physical, chemical and mechanical triggers. Many factors also influence the rate of repigmentation with vitiligo treatment, including the density of hair follicles. Dermatologists can help you navigate the vast and complex factors within each of these processes.

Takeaway #3: It’s important to see a dermatologist regularly if you live with vitiligo

What’s the most important thing you can do if you live with vitiligo? Given that vitiligo is an autoimmune disease and a complex condition, the answer is simple: see a dermatologist on a regular basis to talk about your vitiligo and your overall health.

“The important thing to recognize is that if you have vitiligo, it’s not just a skin condition, it’s an autoimmune condition,” said Dr. Nasir, explaining the need to see a dermatologist. “It’s important to get yourself checked, to see a specialist, and have regular checkups throughout your journey.”

Regular appointments allow you to talk to your dermatologist about your goals and how to manage your vitiligo with these goals in mind. Seeking overall health? Dermatologists are experts in looking at the skin and catching abnormalities that may appear differently because of your vitiligo. They can also help monitor other symptoms to help screen for related autoimmune diseases. Looking to slow your depigmentation? Dermatologists can help you identify common triggers and learn how to manage them. Looking to repigment? Dermatologists can discuss treatment options. Meeting with a vitiligo specialist in particular can also ensure that you get the most up-to-date information on treatments.

Watch the webinar replay

Looking for more? Watch the full interview with Dr. Nasir below to hear his answers to key questions about the science of vitiligo, including the role of the immune system, the process of depigmentation and how to manage your vitiligo over time.

Looking for a particular topic? Use our topic guide below to help navigate the webinar:

The Science of Vitiligo Webinar Topic Guide:
00:00 – Introduction
1:44 – Vitiligo Overview
4:03 – The Science Within the Skin Animated Video
8:28 – Vitiligo & the Role of the Immune System
14:02 – The Process of Depigmentation
22:28 – Vitiligo Management
30:39 – Q&A
35:34 – Key Takeaway

Vitiligo Q&A

What else do you want to know about vitiligo? That’s exactly what we asked our readers—and received the following submissions from the community. Below you’ll find evidence-backed answers to these questions to help you learn even more about this condition.

Genetic/Hereditary Component 

You asked: 

• Is there a gene that can be tested to find out if one has an increased chance of developing vitiligo (such as that for testing the likelihood of getting some familial cancers)?
• Can I have kids with vitiligo since I have vitiligo?
• Can a breastfeeding mother transmit vitiligo to her infant child?

The answers: 

• Genetics plays a role in vitiligo, along with environmental factors. Studies have found a connection between certain genes and vitiligo, as well as other autoimmune conditions. ⁱ
• The development of vitiligo has been linked to variations in a number of genes. While there are tests to detect mutations associated with vitiligo, the pattern for inheritance is complex, so testing positive would not necessarily mean that a person will eventually develop vitiligo. 
• Vitiligo can run in families and an estimated 25-50% of people with vitiligo have a family history with the condition.ⁱⁱ So, while it is possible to have a child with vitiligo if the condition runs in your family, it is not assumed that this will be the case. 
• Vitiligo is not contagious. It cannot be transmitted via bodily fluids, including breast milk. ⁱⁱⁱ

Potential Triggers  

You asked: 

• Is there any way to know what specifically triggered an individual’s vitiligo?
• Can excess sun exposure (but not sun damage) trigger vitiligo?
• Can mosquitos cause vitiligo?
• Can a cut or wound trigger vitiligo?
• Are filler Botox injections safe or can they stimulate more vitiligo patches?
• Can a bad diet trigger vitiligo?
• Are there foods that should be avoided or consumed due to having vitiligo?

The answers: 

• Triggers for vitiligo can vary by person and may include things like genetics, emotional stress and skin trauma. For example, stress could stem from a hectic time at work or in your personal life, or physically, it could be triggered by environmental factors like sunburn.  
• Excess sun exposure can cause skin to lose or gain pigment.ⁱ In the summer, the depigmented patches may be more noticeable as the nearby pigmented skin gets darker. People with vitiligo should limit their exposure to the sun and wear sunblock to prevent burning of their lighter spots.^iv  
• The Koebner phenomenon helps explain how a physical injury can trigger certain skin conditions, including vitiligo. The Koebner phenomenon occurs when a skin injury like a bug bite, injection, or even a sunburn causes new skin lesions to appear. In vitiligo, the Koebner phenomenon can trigger the onset of depigmented patches of skin.^v  While not everyone who physically injures their body will get vitiligo and not everyone who gets vitiligo will experience the Koebner response, this can be the cause or progression of vitiligo for some.
  • A cut, wound or bite could potentially be a trigger.
  • Cosmetic treatments like Botox or filler have not been commonly reported as a trigger for the Koebner phenomenon. If you are considering a similar injection, talk to your dermatologist about any concerns you may have.
• No studies to date have shown a correlation between a bad diet and vitiligo.^vi However, since vitiligo is related to inflammation, some suggest avoiding inflammatory foods like processed meat and soda, in favor of foods that advance overall wellness like whole grains and nuts.
• It’s important for people with vitiligo to note when their condition progresses, so they can try to identify what might be triggering it.

Vitiligo Management 

You asked: 

• What are effective strategies to keep vitiligo from spreading?
• Are high levels of Vitamin D helpful/safe for repigmentation?
• What skincare can I use to combat aging/wrinkles at 45+ with vitiligo on my face?
• Is red light therapy a consideration for effective treatment for vitiligo?
• Since vitiligo is autoimmune, wouldn’t it be better treated internally versus externally with creams and ointments?
• In Africa, it is very hot, and sunscreen is expensive. Are there alternatives?
• Can you cover vitiligo with makeup?
• What are effective hygiene methods for people living with vitiligo?
• Does vitiligo cause body odor? If so, what solutions exist?

The answers: 

• Because vitiligo is a chronic autoimmune condition, it can be unpredictable. ⁱ While there is no cure, it can be managed over time in partnership with a healthcare provider.
• An important part of managing vitiligo includes identifying your triggers so you can potentially avoid things that may cause your vitiligo to spread, if possible.
• It is important to see a dermatologist regularly to check your skin, address specific needs, and determine and maintain the best management plan. An individualized plan is important, and different approaches can offer options to help some people successfully achieve their desired goals.
• There is a connection between Vitamin D deficiency and autoimmune conditions like vitiligo. It is not known if Vitamin D in combination with other treatments could be effective in people with vitiligo.^vii As noted in the video, repigmentation is a long and complex process, much like the complicated processes of pigmentation and depigmentation. The time it takes to repigment the skin can vary by person and by the location of the white patches on the body.ⁱ 
• Please consult your dermatologist to advise on recommended skin care and answer any questions about potential therapies.
• Wearing sunscreen and sun-protective clothing is an important way to protect your skin from the sun and potential pigment loss.^viii Avoiding the sun when possible is also helpful.
• Some people may choose to wear makeup to cover their vitiligo. Some makeup may contain SPF and provide additional protection against the sun.
• Vitiligo is an autoimmune condition and is not linked to body odor. If you have questions about your personal hygiene and vitiligo, speak to your dermatologist.

To learn more about vitiligo, visit ThisIsVitiligo.com and talk to a dermatologist about a management plan for you. 

Thank you to Dr. Nasir and Incyte for their partnership on the webinar and for creating wonderful resources like The Science Within the Skin video. If you found this information valuable, feel free to share with another member of the vitiligo community, a family member or a friend. 

References: 

1. Wang Y, Li S, Li C. Clin Rev Allergy Immunol.2021;61(3);299-323.
2. National Institutes of Health. Genetic and Rare Diseases Information Center. Skin Diseases. Vitiligo. 2018.
3. Liu K. Vitiligo: More than skin deep – Harvard Health Blog. Harvard Health Blog. Published September 26, 2019. https://www.health.harvard.edu/blog/vitiligo-more-than-skin-deep-2019092617885.
4. U.S. Food and Drug Administration. The voice of the patient: A series of reports from the U.S. Food and Drug Administration’s (FDA’s) patient-focused drug development initiative. https://www.fda.gov/media/155068/download.
5. Van Geel N, et al. Koebner’s phenomenon in vitiligo: European position paper. Pigment Cell & Melanoma Research, 24(3), 564–573.
6. Grimes PE, Nashawati R. The Role of Diet and Supplements in Vitiligo Management. Dermato Clin 35. 2017.
7. Piotrowska A, Wierzbicka J, Zmijewski MA. Vitamin D in the skin physiology and pathology. Acta Biochim Pol. (2016) 63:17–29. doi: 10.18388/abp.2015_1104
8. American Academy of Dermatology. Is vitiligo a medical condition. Accessed on October 14, 2024. https://www.aad.org/public/diseases/a-z/vitiligo-medical-condition.

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