How Is Vitiligo Diagnosed?
Medically reviewed by William Truswell, MD
Vitiligo is diagnosed through a physical exam, blood test, and biopsy. Vitiligo causes loss of skin color or pigment in areas around the body. If you have vitiligo symptoms, such as lightened patches on your skin and premature hair whitening, you may see a dermatologist who specializes in skin conditions. They can perform different tests to reach a diagnosis.
This skin condition is an autoimmune disorder, meaning the immune system mistakenly attacks healthy cells. In the case of vitiligo, the immune system targets the melanocytes. These skin cells produce melanin, the pigment that gives your skin color. Genetic factors and environmental triggers may play a role in causing vitiligo.
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Related: How Are Hives (Urticaria) Diagnosed?
Self-Check Exam
It's important to perform a self-check skin exam at home to look for unusual signs or symptoms. No home tests can test for vitiligo, but you can check if you have depigmented areas.
These are the most common vitiligo symptoms that people can develop. Consult a dermatologist if you notice:
Changes in your eye color
Hair turning white or gray
Itchy skin, especially if it's accompanied by discoloration of any kind
Light patches on the lips and around the mouth and nose
Lightened patches on the face, arms, and feet
It's possible for vitiligo to lead to hearing loss, as the inner ear contains melanocytes. Hearing loss can occur when these cells are attacked. Vitiligo can also make your skin more sensitive to ultraviolet (UV) light, increasing your risk of sunburn.
Take note of the areas that have lost their pigment, which can help a dermatologist determine what type of vitiligo you may have. The three types of vitiligo are:
Mucosal: This type affects the mucous membranes in your mouth, nose, or genitals.
Non-segmental vitiligo: This is the most common form of vitiligo. Non-segmental vitiligo can affect both sides of your body in any area, especially the face, neck, genitals, and hands.
Segmental vitiligo: This develops on only one side (i.e., left or right) or body part, such as the face or hands. The patches generally appear small in size.
Physical Exam and Medical History
A healthcare provider will perform a physical exam and ask about your medical history and symptoms. Let them know if you have a family history of vitiligo or another autoimmune disorder like diabetes. One-fifth of people with vitiligo also have a close relative with the skin condition.
A healthcare provider may also ask if you've recently developed skin rashes or tried treating the affected areas at home. It's important to disclose any medications or creams you've used at home, as these can affect the treatments they prescribe.
Wood's Lamp Exam
A healthcare provider may use an ultraviolet (UV) lamp, called a Wood's lamp, to examine your skin. This type of exam takes place in a dark room. The UV light helps distinguish patches related to vitiligo or other conditions. The patches appear bright blue-white if you have vitiligo and a light skin tone.
Blood Tests
A healthcare provider may recommend blood tests to confirm a vitiligo diagnosis. These tests help them determine whether you may have another autoimmune disorder, such as a thyroid disorder.
Thyroid disorders include:
Hypothyroidism: Your thyroid gland does not produce enough hormones. Symptoms include fatigue, sensitivity to cold, constipation, dry skin, and weight gain.
Hyperthyroidism: Your thyroid gland makes more hormones than what your body needs. Symptoms include weight loss, sweating, rapid or irregular heartbeat, and mood changes.
Blood tests, such as thyroid function tests, can indicate whether you have low or high levels of thyroid-stimulating hormone (TSH) in your blood.
Biopsy
A healthcare provider may perform a skin biopsy if they need to know more about your skin cells. The dermatologist will take a sample of your skin and examine it under a microscope. They can confirm you have vitiligo if the sample does not have pigment-producing cells.
Eye Exam
Many people with vitiligo have depigmentation on their eyelids. They may also have white hairs in their eyebrow and eyelash area.
Some people with vitiligo develop vision problems, but this is a rare occurrence. You may have to see an ophthalmologist to check if you have uveitis, or inflammation in your eyes. Research has found that uveitis affects about 4.8% to 19% of people with vitiligo. It can be beneficial to attend regular eye exams, especially if you have vitiligo patches on your head and neck.
Hearing Exam
Hearing loss happens when the immune system attacks the pigment cells inside your ear. If you have hearing problems, an audiologist specializing in assessing and treating hearing and balance issues, an ear, nose, and throat doctor, or a doctor specializing in ontology (treating medical and surgical conditions of the ears) can examine you.
Some evidence suggests sensorineural hearing loss is a common symptom among people with vitiligo. This hearing loss develops when there is damage to the inner ear or auditory nerve.
Screening for Related Conditions
Other skin conditions can cause white patches. Dermatologists use different tests to distinguish the symptoms between vitiligo and other disorders. Conditions that produce similar skin symptoms to vitiligo include tinea versicolor, albinism, pityriasis alba, and idiopathic guttate hypomelanosis.
Tinea Versicolor
A fungal infection causes tinea versicolor. The skin condition can cause discoloration, skin dryness, and flakiness. The affected skin areas look yellow under the Wood's lamp, while vitiligo appears bright blue.
Albinism
Albinism is a genetic condition associated with skin discoloration that can affect a person's eyesight. People with albinism usually have very pale skin and light blonde hair. The condition is usually diagnosed at birth. Healthcare providers check if the baby has any discolored areas on their skin, hair, and in their eyes.
Albinism can cause vision problems, such as misaligned eyes, light sensitivity, or uncontrollable rapid eye movement. An eye exam may be helpful to examine the baby's eye health and look for signs that indicate albinism.
A healthcare provider may advise genetic testing if you have a family history of albinism. This testing can indicate the type of albinism you have.
Pityriasis Alba
Pityriasis alba is known to cause round or oval hypopigmented (light-colored) lesions. The skin disorder affects mostly children and adolescents. A dermatologist may perform a Wood's lamp exam to diagnose the disorder. There is no color change under the lamp in the hypopigmented areas.
Idiopathic Guttate Hypomelanosis
Idiopathic guttate hypomelanosis causes small, flat areas of white depigmented skin, as there is a decrease in melanin pigmentation. The disease mostly occurs in areas that have had a lot of sun exposure, such as the shoulders. Older adults who have fair skin are likelier to have the disease than others.
A skin biopsy helps dermatologists reach a diagnosis. A biopsy can check if there is decreased melanin in the cells.
Related: How Is Psoriasis Diagnosed?
A Quick Review
Vitiligo is a skin condition that causes lightened patches on the skin and hair discoloration. Dermatologists use different tests to diagnose vitiligo and rule out other conditions that cause similar symptoms.
Some of these tests include blood tests and a skin biopsy. If you develop vision or hearing problems, an ophthalmologist and an audiologist may perform additional tests.
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