White patches on the skin are a very common reason for dermatology consultations. They don’t always mean the same thing or have the same cause. In some cases, they are due to dryness, eczema, or repeated sun exposure, and in others they correspond to pigmentation disorders such as vitiligo. Therefore, when these lesions appear, it is important to see a dermatologist for an accurate diagnosis.
If you want to learn more about other types of spots, we recommend reading about white spots on the face: types, causes, and treatment.
Vitiligo: meaning and definition
Vitiligo is a chronic skin condition in which melanocytes—the cells responsible for producing melanin (the pigment that gives color to the skin, hair and, to a lesser extent, some mucous membranes)—are destroyed or stop functioning. As a result, well-defined white patches of varying size and shape appear, which may increase over time.
Key points about vitiligo:
- It is a non-contagious disease.
- It can affect people of any age, although it most commonly appears between 10 and 30 years old.
- It affects men and women equally and can appear in all skin phototypes (light or dark skin).
- It is not painful; sometimes it may be accompanied by slight dryness or itching, especially if other skin conditions coexist.
What causes vitiligo? Involved factors and triggers
The exact origin of vitiligo is complex and multifactorial. Several theories attempt to explain why melanocytes are destroyed:
1. Autoimmune theory
This is the most widely accepted hypothesis. In vitiligo, the immune system mistakenly identifies melanocytes as “foreign” and attacks them, leading to their progressive destruction. It is not uncommon for some people with vitiligo to also have other autoimmune diseases (such as thyroid disorders), which is why dermatologists may request additional tests.
2. Metabolic theory and oxidative stress
Another theory highlights the role of oxidative stress. An excess of free radicals and an imbalance in the skin’s antioxidant mechanisms may damage melanocytes, altering the synthesis and transport of melanin.
3. Neurogenic theory
This proposes that certain neurochemical substances released by cutaneous nerve endings could be toxic to melanocytes and trigger their destruction.
4. Genetic factors and family history
In approximately 20% of cases, vitiligo appears in several members of the same family, indicating a hereditary predisposition. Having a family history does not mean you will necessarily develop it, but the risk may be somewhat higher.
5. Triggering factors (including stress)
Although the underlying cause is usually genetic or autoimmune, different factors can act as “triggers” or worsen the condition:
- Intense or prolonged emotional stress.
- Significant sunburns or repeated skin trauma.
- Local injuries (Koebner phenomenon: new lesions appear in areas subjected to friction or microtrauma).
- Certain hormonal factors or life changes (puberty, pregnancy, etc.).
It is important to emphasize that stress alone does not “create” vitiligo, but it can trigger flare-ups or favor the spread of lesions in predisposed individuals.
Who is more likely to develop vitiligo?
Anyone can develop vitiligo, but the risk is higher when:
- There is a family history of vitiligo or other autoimmune diseases.
- The person has associated autoimmune conditions (e.g., autoimmune thyroiditis).
- They have experienced intense or repeated sunburns.
- They go through prolonged periods of physical or emotional stress.
Still, in many patients no clear trigger is identified, so the approach must always be individualized by the dermatologist.
Vitiligo: what the patches look like and where they appear
Vitiligo patches are usually:
- White and well-defined, sometimes with a slightly darker border.
- Variable in size: from small dots to larger plaques.
- Often symmetrical (for example, on both sides of the body).
The most common areas for vitiligo patches include:
- Face (especially around the mouth and eyelids).
- Palms of the hands and soles of the feet.
- Nipples and breast area.
- Armpits.
- Abdomen (especially around the navel).
- Lower back and sacral region.
- Groin and anogenital area.
- Elbows, knees, and fingers/toes.
In some cases, the scalp, eyebrows, eyelashes, or body hair may also be affected, producing localized depigmented hair (white hairs in the affected areas).
Diagnosis of vitiligo
The diagnosis of vitiligo is mainly clinical, meaning the dermatologist identifies it by examining the skin. Sometimes they may use:
- Wood’s lamp, which highlights depigmented areas.
- Blood tests to rule out associated diseases (such as thyroid issues).
- A skin biopsy in doubtful cases to distinguish it from other causes of white patches.
It is important to differentiate vitiligo from other causes of depigmentation or hypopigmentation, such as idiopathic guttate hypomelanosis or certain forms of dermatitis. If unsure, avoid self-medication and always consult a dermatologist.
How is vitiligo treated?
Residual melanocytes have been found in the skin affected by vitiligo, located in deep structures such as the hair follicle root (“dormant melanocytes”). The goal of treatment is to stimulate their activity and encourage them to migrate to the surface, helping to repigment depigmented areas.
Treatment is always individualized and depends on:
- The activity of the condition (stable or progressing).
- The location of the lesions.
- The extent of white patches.
- Patient age and associated health issues.
Common therapeutic options (always under medical supervision)
- Topical corticosteroids: creams or lotions used for limited periods under dermatological supervision.
- Topical calcineurin inhibitors: useful in delicate areas such as the face, neck, or skin folds.
- Systemic treatment (corticosteroids or other immunomodulators): reserved for selected cases.
- Antioxidant creams and specific formulas that help combat oxidative stress in the skin.
- Phototherapy (narrowband UVB, among other modalities): considered the gold standard in many cases, always in specialized units.
- Cosmetic camouflage (makeup for vitiligo) as aesthetic and emotional support.
No treatment is universal or guarantees complete repigmentation, but a constant, combined approach guided by a dermatologist can significantly improve the appearance of the skin and the person’s quality of life.
Dermocosmetic care for vitiligo: Sesderma’s Vitises line
In addition to medical treatment, daily skincare is key to protecting depigmented areas and optimizing results. At Sesderma, the Vitises line is specifically formulated for complementary care of vitiligo-affected skin.
Depending on the specialist’s recommendation, the dermocosmetic routine may include:
- Gentle cleansing with products that respect the skin barrier.
- Specific topical treatments from the Vitises range, with active ingredients aimed at caring for vitiligo-affected skin.
- Very high photoprotection daily on exposed areas to minimize contrast between healthy and depigmented skin.
If you are also concerned about other types of skin spots, you can learn more about which anti-spot cream dermatologists recommend according to your type of hyperpigmentation or hypopigmentation.
Vitiligo and stress: what is the relationship?
Many people report that the first spots or the spreading of existing ones coincided with periods of intense stress, grief, or significant personal or work-related changes. Stress is not the sole cause of vitiligo, but it can:
- Act as a trigger for initial flare-ups in predisposed individuals.
- Promote the progression of the condition when prolonged.
For this reason, within a comprehensive approach to vitiligo, it is advisable to care for emotional well-being too: stress-management techniques, physical activity, proper rest, and psychological support when needed.
Other causes of white patches on the skin that are not vitiligo
Not all white patches indicate vitiligo. Other conditions can produce hypopigmentation or partial depigmentation:
Atopic dermatitis
Atopic dermatitis is a chronic inflammatory skin disease, non-contagious, with alternating flare-ups and remission phases. It is characterized by:
- Very dry and sensitive skin.
- Red patches or eczema with intense itching.
- Lesions that may leave lighter areas after inflammation (post-inflammatory hypopigmentation).
There is a genetic predisposition (atopy) and an alteration of the skin barrier function, making the skin more permeable and susceptible to irritants and allergens. Treatment is based on specific dermocosmetic care, intensive hydration, and when necessary, topical corticosteroids or immunomodulators prescribed by a dermatologist.
Idiopathic guttate hypomelanosis
Idiopathic guttate hypomelanosis is characterized by small, round white spots, mainly on the legs, arms, shoulders, neck, and face—areas frequently exposed to the sun. It usually appears from age 20–30 and is associated with:
- Photoaging of the skin.
- Chronic sun exposure.
- Genetic predisposition in some cases.
The lesions are benign and pose no health risk, but they may have an aesthetic impact. Prevention relies on good sun protection and avoiding intense, repeated sun exposure.
Recommendations to care for and prevent the worsening of white patches
Although vitiligo cannot always be prevented, it is possible to protect the skin and avoid lesion worsening or increased contrast between healthy and depigmented skin:
- Apply high or very high photoprotection (SPF 50+) daily to all exposed areas, reapplying frequently.
- Avoid sunburns and intense exposure during peak UV hours.
- Use specific facial sunscreens and, if necessary, oral antioxidant supplements under medical advice.
- Care for the skin barrier with gentle cleansers and moisturizers suited to your skin type.
- Always consult a dermatologist before beginning any depigmenting treatment or aesthetic procedure.
- Pay attention to emotional well-being and seek support if the appearance of the skin affects your quality of life.
What should I do if I have vitiligo?
If you notice the appearance of new white patches or changes in your skin’s pigmentation pattern, the following steps are recommended:
- Make an appointment with a dermatologist to confirm the diagnosis and rule out other conditions.
- Mention whether there is a family history of vitiligo or autoimmune diseases.
- Evaluate with the specialist the most appropriate medical treatment options for your case.
- Establish a supportive dermocosmetic routine (for example, using products from the Vitises line) and a strict photoprotection regimen.
- Have regular follow-ups to adjust the plan as needed.
Remember that the information in this article is for guidance and does not replace individual medical evaluation by a healthcare professional.
Frequently asked questions about vitiligo
What causes vitiligo?
Vitiligo results from the loss or destruction of melanocytes, the cells that produce skin pigment. In most cases, an autoimmune mechanism is involved, influenced by genetic factors and triggers such as stress, sunburns, or certain types of skin trauma.
What should I do if I have vitiligo?
The most important step is to see a dermatologist to confirm the diagnosis and evaluate the most suitable treatment (topical, systemic, phototherapy, etc.). In addition, daily high sun protection is recommended, as well as a specific dermocosmetic routine—such as products from the Vitises line—and caring for emotional well-being.
Who is more likely to develop vitiligo?
Those with a family history of vitiligo or other autoimmune diseases, as well as individuals with certain immune alterations or who have suffered severe sunburns. However, vitiligo can appear in anyone, regardless of skin type.
What causes stress-related vitiligo?
Stress is not the sole cause of vitiligo, but it can act as a trigger in predisposed individuals, promoting the onset or spread of white patches. Stress is believed to alter the balance of the immune system and increase oxidative stress, contributing to melanocyte damage.
Can vitiligo be prevented?
There is no guaranteed way to prevent vitiligo, especially when there is a genetic predisposition. However, you can take measures to protect the skin and reduce risk factors: sun protection, avoiding sunburns, caring for the skin barrier, managing stress, and consulting a dermatologist about any pigmentation changes to begin treatment as early as possible.
