Vitiligo occurs when pigment-producing cells (melanocytes) die or stop producing melanin — the pigment that gives your skin, hair and eyes color. The involved patches of skin become lighter or white. It's unclear exactly what causes these pigment cells to fail or die. It may be related to:

• A disorder of the immune system (autoimmune condition)
• Family history (heredity)
• A trigger event, such as stress, severe sunburn or skin trauma, such as contact with a chemical

Your health care provider will ask about your medical history and examine your skin, possibly with a special lamp. The evaluation might also include a skin biopsy and blood tests.

Medication

Therapy

Surgery

If light therapy and medications haven't worked, some people with stable disease may be candidates for surgery. The following techniques are intended to even out skin tone by restoring color:

• Skin grafting. In this procedure, your doctor transfers very small sections of your healthy, pigmented skin to areas that have lost pigment. This procedure is sometimes used if you have small patches of vitiligo.

  Possible risks include infection, scarring, a cobblestone appearance, spotty color and failure of the area to recolor.

• Blister grafting. In this procedure, your doctor creates blisters on your pigmented skin, usually with suction, and then transplants the tops of the blisters to discolored skin.

  Possible risks include scarring, a cobblestone appearance and failure of the area to recolor. And the skin damage caused by suctioning may trigger another patch of vitiligo.

• Cellular suspension transplant. In this procedure, your doctor takes some tissue on your pigmented skin, puts the cells into a solution and then transplants them onto the prepared affected area. The results of this repigmentation procedure start showing up within four weeks.

  Possible risks include scarring, infection and uneven skin tone.

• Surgery may be an option for people of all skin tones and for people who have different types of vitiligo. However, it’s not an option for everyone.

• Light therapy. Phototherapy with narrow band ultraviolet B (UVB) has been shown to stop or slow the progression of active vitiligo. It might be more effective when used with corticosteroids or calcineurin inhibitors. You'll need therapy two to three times a week. It could take 1 to 3 months before you notice any change, and it could take 6 months or longer to get the full effect.

  Given the FDA warning regarding possible risk of skin cancer with use of calcineurin inhibitors, talk with your health care provider about the risks and benefits of using these drugs with phototherapy.

  For people who can't go to a clinic for treatment, smaller portable or handheld devices for narrow band ultraviolet B therapy are available for home use. Talk with your health care provider about this option as well if needed.

  Possible side effects of narrow band ultraviolet B therapy include redness, itching and burning. These side effects usually clear up within a few hours after treatment.

• Combining psoralen and light therapy. This treatment combines a plant-derived substance called psoralen with light therapy (photochemotherapy) to return color to the light patches. After you take psoralen by mouth or apply it to the affected skin, you're exposed to ultraviolet A (UVA) light. This approach, while effective, is more difficult to administer and has been replaced in many practices by narrow band UVB therapy.

• Removing the remaining color (depigmentation). This therapy may be an option if your vitiligo is widespread and other treatments haven't worked. A depigmenting agent is applied to unaffected areas of skin. This gradually lightens the skin so that it blends with the discolored areas. The therapy is done once or twice a day for nine months or longer.

  Side effects can include redness, swelling, itching and very dry skin. Depigmentation is permanent.

Surgery usually isn’t recommended for people who have active vitiligo, which means that over the last 12 months new spots have developed or existing spots have grown.

Surgery also may not be an option for people who developed raised scars. Surgery could cause scarring.