How To Tell The Difference Between Vitiligo & Other Skin Pigmentation Changes

Over time, we all notice changes in our skin tone, texture, and pigmentation. A lot of those changes are just the wear and tear from a life well-lived, but sometimes the shifts seem more serious.

If you’ve noticed that spots on your skin look significantly lighter than the surrounding areas, it can be alarming. You might even wonder if you’re seeing the early stages of vitiligo, a condition that affects approximately .36% of the world’s population.

However, many other conditions can cause uneven pigment in your skin, explains Dr. Patrick Brunner, MD, an associate professor of dermatology at the Icahn School of Medicine at Mount Sinai and director of the Cutaneous Lymphoma Clinic at The Kimberly and Eric J. Waldman Department of Dermatology. Those include sun damage, scarring, fungal infections, and some forms of skin cancer, says Brunner.

Obviously, the treatment for all of those conditions varies significantly, which is why it’s important to get a diagnosis from a board-certified dermatologist, says Dr. Nada Elbuluk, MD, MSc, FAAD, a professor of clinical dermatology at the University of Southern California’s Department of Dermatology at Keck School of Medicine and founding director at the Skin of Color and Pigmentary Disorders Program.

That said, if you landed here looking for some preliminary advice while waiting on an appointment with your derm, we’ve got you. Here, we asked experts for the straightforward, practical info you need to seek a diagnosis or just make sense of changes you see in your skin.

Vitiligo Is An Autoimmune Disorder

Like eczema and psoriasis, this condition is a byproduct of the immune system mistaking structures in the body for an infection or something it needs to eliminate. With vitiligo, the immune system targets stem cells responsible for pigmenting skin and hair, says Brunner. When that happens, white or pink patches can appear as those areas lose pigment.

Vitiligo Can Appear On Any Part Of Your Body

There are two kinds of vitiligo. With segmental vitiligo, the patches appear on either the right or left side of the body. Non-segmental vitiligo appears all over, explains Brunner. For some, the patches stay stable; for others, the depigmentation spreads over time. “It’s very individual,” he adds.

Vitiligo Can Impact Your Hair

Because the stem cells that pigment your skin are the same ones that pigment your hair, vitiligo can impact the strands on your head, your eyebrows, lashes, and more. That said, not all vitiligo will progress this far, says Brunner.

Vitiligo Isn’t Caused By Skin Damage

Sometimes depigmentation can occur after receiving an injection, such as a cortisone shot for joint pain, especially in darker skin types, explains Brunner. Those with a history of chronic sun exposure may also develop small white patches due to a condition called idiopathic guttate hypomelanosis. While it’s pretty simple for a doctor to tell the difference between skin damage and vitiligo, some patients may worry while waiting for an official diagnosis, he adds.

Vitiligo Isn’t Dangerous

Unlike some of the other conditions often confused for vitiligo, like forms of skin cancer, sun damage, and fungal infections, vitiligo itself isn’t harmful or life-threatening. That’s not to say that the emotional impact of hypopigmentation does not impact a person’s quality of life, because it certainly can, says Elbuluk. Still, the depigmented patches are physically harmless.

Vitiligo Can Be Accompanied By Other Autoimmune Conditions

Vitiligo is caused by a malfunctioning immune system, so those who have it may be more likely to have other autoimmune conditions, says Brunner. In fact, vitiligo has been associated with thyroid disease and eczema.

That’s just another reason why getting a diagnosis is so beneficial. Once you know what you’re dealing with, you can treat the condition and any others that might be related to it, says Elbuluk.

Sometimes Vitiligo Patches Can Be Repigmented

When you have a vitiligo patch, the pigment cells, called melanocytes, are gone. But the stem cells responsible for creating pigment may still exist, says Brunner. That’s most often the case when the patches are relatively new, he says. After a diagnosis, a doctor can see if there are still stem cells available in your hair follicles (that’s where they live). “When those hairs are still pigmented, there are still stem cells available that can repigment your skin,” he explains. It’s not possible for everyone — and it takes time — but with the help of an experienced doctor, you’ll better understand what your options are, Brunner adds.

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