What causes vitiligo? Is it common? Can it be treated or will it go away naturally? Here, DR CARMEN LAM answers our questions on this often-misunderstood skin condition. She also shares details of a new vitiligo treatment in Hong Kong.
Tell us about this skin condition and the causes of vitiligo.
Vitiligo causes patches of the skin or hair to turn white. While we don’t know the exact causes of the skin condition, we do know that it’s brought about by the destruction or malfunction of melanocytes, cells that are responsible for pigment production. Some studies say it can be related to an autoimmune disorder, genetic matters or oxidative stress (an imbalance between free radicals and antioxidants in the body).
How common is it globally? What about here in Hong Kong?
Around half a percent to two percent of the world’s population is thought to have vitiligo. In Hong Kong, it’s around one percent. So, around 75,000 people are affected here – quite a big number.
Are particular groups more commonly affected?
Among Hongkongers, males and females are equally affected, and it can appear at any age, from early childhood to much later in life. But studies have found that the peak incidence is around the second and third decades of life. More than half of patients get the disease before age 20, and as many as one-third of affected patients are children. Despite this common early onset, some parents are very surprised to discover their children have vitiligo.
What are the symptoms of vitiligo?
There are two major types of vitiligo. The first is called the segmental type. This is characterised by localised whitish patches on one side or one area of the body, which usually appear early in a person’s life. The other type is non-segmental vitiligo, which is a more common form. It leads to symmetrical whitish patches that may spread over time. The disease affects all skin types and skin tones. Usually, patients will have symptoms like pain or itchiness, but it’s also a condition that can have a big effect on daily life and self-esteem.
How is it diagnosed?
After reviewing a patient’s medical history, the doctor will take a good look over their skin and their overall skin condition. This can involve a device known as Wood’s Light (or Wood’s Lamp), which uses a kind of ultraviolet light to reveal vitiligo patches as shiny, bluish-white areas. A skin biopsy is usually not necessary.
What are some of the physical effects?
Some people think it’s solely a cosmetic issue but that’s not true; it can affect our body health as well. For instance, the condition can be related to or associated with certain autoimmune diseases, including thyroid problems. Also, some studies show that the antibody can affect hearing, leading to hearing impairments in patients. (The studies suggest this happens in around 12 to 38 percent of cases.)
There is also the mental side of this skin condition. Can you touch on some of the issues around social stigma and cultural perceptions?
Because of the whitish patches it causes, vitiligo can affect a patient’s self-esteem and their self-image. The emotional burden of the condition is more obvious in female patients. Studies have found that some female patients report feeling ugly or undesirable, with three in five of these patients frequently hiding their vitiligo with makeup, concealer and clothing. Studies have also found that more than half of patients will experience a different degree of effect on their mental wellbeing. More than a third of patients report a certain degree of anxiety and another one third a degree of depression.
Is vitiligo contagious?
No. While the appearance of the pigmentation patches can make some people think that it’s a kind of fungal infection, in fact it’s not an infectious disease.
Are vitiligo treatment options easily accessible?
Traditional vitiligo treatments include topical steroid, which people generally need to use for months or even longer to see re-pigmentation. But the long-term use of steroid cream can cause side effects like thinning of skin, redness and acne, so that is a concern. Another type of topical medication is an immunomodulator (or calcineurin inhibitor), which can be helpful for some facial vitiligo. Phototherapy involves the use of narrowband UV light therapy, but there are concerns with its use around skin cancer and burns.
In some cases where the disease is progressing very rapidly, we do use oral steroids or oral immunosuppressants, but this medication can cause some of those systemic side effects previously mentioned.
A surgical option is available for very stable patients, but we rarely use it. This is because it’s not easy and the cosmetic result may not be satisfactory after surgical management. It’s really only for people who have unsuccessfully tried other means of treatment and who have a very stable case of vitiligo.
Happily, there are new treatments becoming available now. These include a topical cream called ruxolitinib, which is an FDA-approved option to treat vitiligo today.
Tell us more about this new cream.
It works by inhibiting the JAK protein, which helps to reduce the destruction of the melanocytes that produce pigment. In July 2022, the FDA approved the medication for treatment of non-segmental vitiligo – the most common type – in patients 12 years and above.
As for the results of using the cream, these have been quite promising. Studies have found that after six months of use, around half of patients experience a 50 percent improvement of vitiligo on the facial area. Around a third of patients experience a 75 percent improvement of vitiligo in the same area. After one year of use, around one half of patients experience a 75 percent improvement of their facial vitiligo.
What can a patient expect from this new vitiligo treatment in terms of application and recovery?
There can be some local itchiness and irritation when applying ruxolitinib, but any systemic complication is rare because it’s just a topical use medication.
Can you give us an example of a patient case study and how their condition has been treated?
One patient I saw was a 14-year-old who had an onset of whitish patches over her face. As you know, adolescents are more aware of how they look than other age groups. She ended up being bullied and she stopped going to school for almost a year. Her parents assumed it was a non-treatable disease, and they relied on a traditional method that didn’t prove useful. She was diagnosed with depression by a psychiatrist and finally referred to see a dermatologist.
Within six months of using the new vitiligo treatment, she’d already gained a lot of pigment in her patches. She started to go back to school and to make friends again.
This medication is also useful for people with long-standing vitiligo. I have a middle-aged patient who heard about the new treatment and decided to see a doctor again after being told for around 10 years that nothing could really be done.
So, it’s a very promising innovation for new and older patients alike.
Are there any preventive steps people can take to avoid vitiligo?
Unfortunately, no. However, there are some protective measures you can take if you have vitiligo. Because the patches are more prone to sunburn and sun damage, and sun exposure can make the surrounding skin darker and more contrasting, it’s important to use good sun protection. On the mental side, as with any kind of disease, maintaining a healthy lifestyle will definitely help.
This article first appeared in the Autumn 2025 issue of Expat Living magazine. You can purchase the latest issue or subscribe so you never miss a copy!
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