Vitiligo produces smooth, flat patches of skin that have lost their color, ranging from lighter than your natural skin tone to completely white. The patches have no raised texture, no scaling, and no pain or itching. They can appear anywhere on the body but tend to show up first on the hands, face, and areas around body openings like the mouth, eyes, and genitals. Roughly 28.5 million people worldwide have vitiligo, with a global prevalence of about 0.36%.
Color and Texture of Vitiligo Patches
The hallmark of vitiligo is skin that has lost its pigment-producing cells entirely. Early patches may look slightly lighter than surrounding skin, but over time they typically progress to a milky or chalk-white color. The skin itself feels completely normal. There’s no roughness, no flaking, and no change in texture. If you run your finger over a vitiligo patch, it feels identical to the skin around it.
Under a special ultraviolet light called a Wood’s lamp, vitiligo patches fluoresce bright blue-white. This glow is always present in true vitiligo, which is one reason dermatologists use the lamp as a diagnostic tool. It also reveals patches that may not yet be visible to the naked eye, especially on lighter skin.
Where Patches Typically Appear
Vitiligo favors certain locations on the body. The face, neck, and scalp are common. So are areas around body openings: the lips, nostrils, eyes, ears, and genitals. Hands, arms, and bony areas like knuckles, elbows, and knees are also frequent sites, likely because these spots experience more friction and minor trauma in daily life.
Pigment loss can also occur inside the mouth and on the lips themselves, turning the normally pink or brown tissue pale. Some people notice color changes in the inner lining of the nose as well.
How It Looks on Different Skin Tones
Vitiligo affects all skin tones equally, but the contrast between patches and surrounding skin varies dramatically. On darker skin, the white patches are immediately obvious and can be the first thing a person or their family notices. On very fair skin, vitiligo patches may be difficult to see indoors and only become apparent in summer, when surrounding skin tans but the affected areas stay pale and burn easily. This difference in visibility sometimes delays diagnosis for lighter-skinned individuals.
Types and Patterns
Not all vitiligo looks the same. The pattern of patches helps classify the condition into several types:
- Focal vitiligo involves just a few spots in a small area, sometimes remaining stable for years.
- Segmental vitiligo affects only one side of the body, such as one arm, one leg, or one half of the face. It does not cross the midline of the body and tends to appear at a younger age.
- Generalized vitiligo is the most common form, with scattered patches appearing on both sides of the body in a roughly symmetrical pattern.
- Universal vitiligo involves pigment loss across more than 80% of the body’s surface. This is rare.
Hair Color Changes
Vitiligo doesn’t just affect the skin. The same pigment-producing cells exist in hair follicles, and when they’re destroyed, the hair growing from that area turns white. This can happen on the scalp, eyebrows, eyelashes, and body hair. In some cases, people notice significant whitening of body or scalp hair before any skin patches appear. White hairs within a vitiligo patch are considered a sign that the pigment cells in the hair follicle have been depleted, which can affect how well that area responds to treatment.
How New Patches Form After Skin Injury
A phenomenon called the Koebner response can influence where vitiligo appears. When the skin is injured through a cut, scrape, sunburn, tattoo, or even friction from tight clothing, new vitiligo patches can develop at that exact spot. These trauma-triggered patches typically appear within 10 to 20 days of the injury and often run in a straight line following the shape of the wound. This explains why some people develop vitiligo along a scar, at the site of a scratch, or in areas that experience repeated rubbing.
Conditions That Look Similar
Several other skin conditions cause lighter patches and are sometimes confused with vitiligo. The differences are worth knowing.
Pityriasis alba, which is linked to eczema, causes faintly lighter patches on the cheeks, elbows, or behind the knees. These patches are hypopigmented (lighter) rather than fully white, and they may have a slightly rough or dry surface. Tinea versicolor, a common fungal condition, creates lighter spots on the chest and back that become scaly when scratched. Progressive macular hypomelanosis looks similar to tinea versicolor but without any scaling.
Idiopathic guttate hypomelanosis produces tiny white spots, usually 1 to 2 millimeters across and almost always under 5 millimeters, scattered evenly on sun-exposed areas like the arms and shins. These spots are lighter but not truly white, and they stay small. A birthmark called nevus depigmentosus can appear in the first few months of life with jagged edges. It grows proportionally as the child grows but doesn’t spread the way vitiligo does.
Piebaldism is a genetic condition present from birth that causes white patches only on the front of the body, often with a distinctive streak of white hair at the front of the scalp. Lichen sclerosus, usually found on the genitals, can produce completely white patches but also causes itching, pain, and sometimes cracking of the skin. Discoid lupus creates lighter spots surrounded by dark borders on the head and neck, along with permanent hair loss in those areas.
One simple test at home: press firmly on the lighter patch and the surrounding skin. If the spot temporarily disappears when you press down and reappears as blood flow returns, it may be nevus anemicus, a harmless vascular birthmark, rather than vitiligo.
How Patches Change Over Time
Vitiligo is unpredictable. Some people develop a single small patch that stays the same size for years. Others experience rapid spreading over weeks or months. The general pattern in nonsegmental vitiligo is gradual expansion, with patches slowly growing at their edges and new spots appearing in other locations. Patches may start as slightly lighter areas before progressing to complete pigment loss. Segmental vitiligo, by contrast, tends to spread quickly within its affected area and then stabilize, often within a year or two.
Spontaneous repigmentation can happen, especially in sun-exposed areas. When color returns, it often appears as small dots of pigment within the white patch, growing outward from hair follicles where some pigment cells may still survive. This speckled pattern of returning color is a characteristic sign that the skin is recovering.