The skin condition where you lose pigment is most commonly vitiligo, an autoimmune disorder that causes milky-white patches to appear on the skin. It affects roughly 0.5% to 2% of the global population, and a large survey across the U.S., Europe, and Japan found an overall prevalence of about 1.3%. Vitiligo is the most well-known cause, but it’s not the only one. Several other conditions can also lighten or erase skin color.
How Vitiligo Works
Your skin gets its color from melanin, a pigment produced by specialized cells called melanocytes. In vitiligo, the immune system mistakenly attacks and destroys those cells. The process typically starts with oxidative stress, a buildup of harmful molecules that damages melanocytes and causes them to release fragments that catch the immune system’s attention. Once alerted, a specific type of immune cell locks onto melanocytes and kills them. The result is smooth, completely white patches of skin where pigment has been wiped out entirely.
The patches can appear anywhere, but they most often show up on the hands, feet, arms, and face. Hair in affected areas can also turn white, including on the scalp, eyebrows, eyelashes, and beard. For many people, the first patches appear before age 20, and it can start in early childhood.
Types of Vitiligo
Most people with vitiligo have the non-segmental type, where patches appear on both sides of the body and tend to spread gradually over time. A less common form, segmental vitiligo, affects only one side or one area of the body. Segmental vitiligo usually starts in childhood, progresses for about 6 to 12 months, and then stops spreading on its own.
Other Conditions That Cause Pigment Loss
Not every light patch on the skin is vitiligo. Several other conditions can look similar but have very different causes and outcomes.
Tinea Versicolor
This is a fungal infection, not an autoimmune disease. It creates lighter (or sometimes darker) patches, most commonly on the shoulders, back, and upper chest. The key visual difference: tinea versicolor patches have a slightly scaly texture, while vitiligo patches are smooth. A dermatologist can confirm the diagnosis by scraping a small sample of skin and examining it under a microscope for yeast, or by shining a UV lamp on the skin, which makes the infected areas glow yellow-green.
Pityriasis Alba
This is extremely common in children and often gets mistaken for vitiligo. It starts as slightly red, scaly round patches, usually on the face, upper arms, or neck. Once the redness fades, it leaves behind lighter-colored spots that don’t tan easily. Pityriasis alba is linked to dry skin and eczema, and most cases clear up within a year without treatment.
Post-Inflammatory Hypopigmentation
After a skin injury, burn, eczema flare, or certain infections, the affected area can lose some of its pigment during healing. This is more noticeable in darker skin tones. Unlike vitiligo, the pigment loss is partial rather than total, and it typically resolves on its own over months, though some cases can take years to fully repigment.
Albinism
Albinism is genetic, present from birth, and affects the entire body rather than appearing in patches. It results from gene mutations that prevent cells from producing melanin normally. The most recognized form causes very pale skin, white hair, and light-colored eyes. Because melanin also plays a role in eye development, people with albinism commonly experience vision problems including light sensitivity, involuntary eye movements, and reduced visual sharpness. There are multiple types, each caused by mutations in different genes, with varying degrees of pigment reduction.
How Vitiligo Is Diagnosed
A dermatologist can often identify vitiligo by appearance alone, but the standard confirmation tool is a Wood’s lamp, a handheld device that emits ultraviolet light. Under this light, depigmented vitiligo patches glow with a distinct bright fluorescence that’s easy to distinguish from normal skin or other conditions. This is especially useful for detecting early or subtle patches in people with lighter skin, where vitiligo can be hard to spot in regular lighting.
Treatment Options for Vitiligo
Vitiligo has no cure, but treatments can restore pigment to affected areas with varying degrees of success. Traditional options include topical corticosteroids and calcineurin inhibitors (anti-inflammatory creams), though their effectiveness is limited.
A newer class of treatment, topical JAK inhibitors, represents a significant step forward. Ruxolitinib cream became the first in this class approved specifically for vitiligo and is now considered a first- or second-line treatment in some countries. These creams work by blocking the immune signaling that drives melanocyte destruction. In clinical trials, patients using topical JAK inhibitors were roughly 3.5 times more likely to achieve significant facial repigmentation compared to those using a placebo cream. Side effects are generally mild, mostly limited to itching or minor acne at the application site.
Narrowband UVB phototherapy, a form of targeted light treatment, is another mainstay. When combined with JAK inhibitors, repigmentation rates improve substantially. One analysis found an average repigmentation increase of about 64% in patients receiving both treatments together, compared to about 49% with a JAK inhibitor alone. Phototherapy works best on the face and neck, with hands and feet being the most resistant areas.
Protecting Depigmented Skin From the Sun
Skin without melanin has lost its natural UV shield, making it far more vulnerable to sunburn. This is a practical, daily concern for anyone with vitiligo or other forms of pigment loss. Most dermatologists recommend sunscreen with SPF 30 or higher on exposed depigmented areas, and surveys of people with vitiligo show that about 85% of those who use sunscreen choose SPF 30 or above. People with more extensive pigment loss tend to reach for even higher SPF levels.
Whether depigmented skin carries a significantly higher skin cancer risk is still debated, but the sunburn risk alone makes consistent sun protection important. Protective clothing and seeking shade during peak UV hours are just as valuable as sunscreen, particularly for large areas of affected skin where applying cream can be impractical.