What Causes Vitiligo and How Is It Treated?
Vitiligo is a condition in which patches of skin turn white because of pigment loss. The patches usually have clear borders, are completely white, and cause no pain or itching. It affects roughly 1 to 2 in every 100 people worldwide, across all ethnic groups and skin tones.
What I would like you to understand from the start is that vitiligo is not contagious, is not a fungal infection, and is not life-threatening. But it affects patients' confidence and quality of life a great deal, especially when it appears on the face or hands, and it is often confused with other conditions that look similar. Getting the diagnosis right from the beginning is important, because the treatments are entirely different.
What causes vitiligo?
Our skin has cells called melanocytes, which produce melanin, the pigment that gives skin its colour. In vitiligo, these cells are destroyed or stop working, so the skin in that area has no pigment and becomes a white patch.
The destruction of pigment-producing cells is believed to result from several factors acting together.
Abnormal immune response, the main mechanism. The immune system mistakes pigment cells for foreign invaders and attacks them. This is why vitiligo often occurs together with other autoimmune conditions.
Genetics. People with a family member who has vitiligo have a higher chance of developing it.
Thyroid disease, especially autoimmune thyroiditis, is commonly found together with vitiligo.
Skin triggers such as wounds, abrasions or severe sunburn. Some people first develop white patches at the site of a past injury.
I want to stress that vitiligo is not caused by eating forbidden foods, by poor hygiene, or by bad karma from a past life, as many people believe. It is an immune-related condition and is not the patient's fault.
Symptoms and distribution
White patches start as small spots or patches that fade until completely white. The edges are usually clear and are sometimes slightly darker than normal skin. Common locations are sun-exposed areas and areas around body openings, such as around the eyes, around the mouth, the hands, elbows, knees and genitals. Hair in the affected area may also turn white.
The patches usually cause no symptoms: no pain, no itching, no scaling. The skin in the area is as smooth as normal skin and differs only in colour. This is what helps distinguish it from tinea versicolor, which is usually scaly and itchy.
How many types of vitiligo are there?
Classifying the type helps the doctor predict how the condition will progress and choose a more suitable treatment. Broadly, there are two groups.
Segmental (one side only) — Appearance: patches are limited to one side of the body and do not cross the midline, and usually begin in childhood / Tendency: spreads quickly at first, then usually stops; responds well to some treatments
Non-segmental (both sides) — Appearance: patches are spread symmetrically on both sides, and this is the most common type / Tendency: progresses in phases and may spread further over time
There are also localised (focal) vitiligo, vitiligo that spreads over almost the whole body (universalis), and vitiligo limited to the face and the tips of the hands and feet (acrofacial). Classification requires an examination by a dermatologist.
How is vitiligo told apart from similar conditions?
This is the part where I see patients get confused most often. White patches on the skin are not always vitiligo, and each condition is treated very differently.
Vitiligo — Colour/appearance: completely white with clear borders / Scale/itch: no scale, no itch / Cause: the immune system destroys pigment cells
Tinea versicolor (Pityriasis versicolor) — Colour/appearance: white or light brown / Scale/itch: fine scale, mild itch / Cause: fungus
Pityriasis alba — Colour/appearance: pale white, indistinct borders / Scale/itch: thin scale, dry skin / Cause: mild skin inflammation, seen in children
Steroid-induced or topical-product-induced hypopigmentation — Colour/appearance: uneven patches, thin skin / Scale/itch: may sting, visible fine blood vessels / Cause: prolonged improper use of topical steroids
A method that helps tell them apart in the clinic is examination with a Wood's lamp, a type of ultraviolet light. True vitiligo glows bright white, unlike tinea versicolor or pityriasis alba. If still uncertain, a skin biopsy can confirm the diagnosis. Investing in the right diagnosis from the start saves you from wasting time on the wrong treatment.
Vitiligo in children
Vitiligo can begin in childhood. Parents are often worried and want to find a treatment quickly. What I would like you to know is that in children it must be carefully distinguished from pityriasis alba, a very common mild dry, inflamed skin condition that clears on its own and is not vitiligo.
If it is truly vitiligo, the good news is that children usually respond to treatment better than adults, especially for patches on the face. It is better to see a dermatologist for a confirmed diagnosis first than to buy a cream yourself, which may be a steroid too strong for a child's skin.
Is vitiligo dangerous, contagious, or able to clear on its own?
Vitiligo is not harmful to the body, is not cancer, and is not contagious, whether through touch, sharing items or being near someone. The main impact is on confidence and mental well-being, which should not be overlooked.
On whether it can clear on its own, the honest answer is that in a minority of people the patches partly regain colour by themselves, but in most they do not clear on their own and may slowly spread if left untreated. Treatment helps stimulate pigment to return and helps stop the spread, so it is best to see a doctor early, while the patches are still new, because new patches respond better to treatment than old ones.
How is vitiligo treated?
Treatment has two goals: to stop the condition from progressing and to stimulate pigment to return. The doctor chooses the method according to the type, location and size of the patches, and the patient's age.
Anti-inflammatory topical medicines, such as calcineurin inhibitors and steroids at an appropriate strength, are used for patches that are not yet widespread, especially on the face. They must be used under a doctor's supervision, because long-term self-use of steroids has side effects.
Ultraviolet light therapy, especially Narrowband UVB, is the standard treatment for patches spread over several areas. It helps stimulate pigment cells to start working again.
The 308 nm Excimer device delivers targeted light and suits patches limited to one area, such as on the face. Treatment is given continuously as a course.
Melanocyte transplantation is for patches that have become stable and have not responded to other methods, especially the segmental type.
Camouflage and sun protection. Cosmetics that cover the patches help confidence during treatment, and sun protection is very important because skin without pigment burns easily and sun exposure makes the colour difference more obvious.
Treatment results differ from person to person and from one location to another. The face usually responds well, while the tips of the hands and feet and areas with white hair are usually harder to restore. I want patients to understand honestly that vitiligo is a condition that can be controlled, not one that disappears with a single application of cream. Be cautious of anyone who advertises a guaranteed 100% cure within a few weeks.
Self-care with vitiligo
In addition to medical treatment, self-care genuinely helps.
Apply sunscreen regularly to protect skin without pigment and reduce the colour contrast.
Avoid friction or injury to the skin, as it may trigger new patches.
Look after your mental health. Vitiligo affects confidence, and talking with your doctor or with someone who understands can help.
Have your thyroid checked as your doctor advises, since the two are often found together.
Frequently asked questions
What causes vitiligo? It occurs when pigment-producing cells are destroyed, mostly by the body's own immune system, together with genetics and other factors. It is not caused by germs or forbidden foods.
Is vitiligo contagious? No. It is not contagious, whether through touch, sharing items or being near someone.
How is vitiligo different from tinea versicolor? Tinea versicolor is caused by a fungus and is scaly and itchy, while vitiligo forms completely white patches with no scale, no itch, and is not contagious. A Wood's lamp examination can tell them apart.
Can vitiligo be cured completely? It is a chronic condition that can be controlled. In many people pigment returns, especially in new patches and on the face, but results differ from person to person. Do not believe guarantees of a 100% cure.
If you or a family member has white patches on the skin and you are not sure whether it is vitiligo, tinea versicolor or something else, having a dermatologist examine it with a Wood's lamp while the patches are still new is the most sensible first step, because the earlier it is diagnosed and cared for, the better the chance that pigment will return. Consult a dermatologist at Siam Dermatology, call +66 61 448 7000 or LINE @siamderm.
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed July 16, 2026
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