Conditions

Vitiligo

What it is

Loss of pigment cells — not an infection, not leprosy

Contagious

No, and it is not caused by any food combination

Best response

Face and neck; hands and feet respond least

Vitiligo is the loss of melanocytes, the cells that give skin its colour, producing sharply defined white patches. It is autoimmune in origin. It is not contagious, it is not caused by anything you ate, and it has nothing to do with hygiene.

Medically it is harmless. Socially, in India, it is often not — and that gap between the clinical picture and the lived experience is worth naming openly in the consultation rather than treating it as a purely cosmetic matter.

How it is assessed

Examination under a Wood's lamp makes patches far clearer, including ones not yet visible to the naked eye, and helps distinguish vitiligo from the conditions that mimic it. Sensation is tested in the patch — this is how leprosy is excluded, and it takes a moment.

Because vitiligo is autoimmune it associates with other autoimmune conditions, most commonly thyroid disease. Thyroid function and, where indicated, other blood tests are checked.

Whether the disease is active or stable is the most important judgement at the first visit, because it determines whether treatment aims to halt spread or to repigment.

Treatment

Topical

Topical steroids in courses, and calcineurin inhibitors such as tacrolimus — particularly on the face and around the eyes, where they avoid steroid-related thinning.

Phototherapy

Narrowband UVB is the most effective treatment for widespread vitiligo. It is given as a course over months, and response is gradual — small islands of colour appear around hair follicles first and slowly coalesce. Patience is part of the treatment.

Surgical

For stable disease: melanocyte transfer, or split-thickness skin grafting, into areas that have not responded to medical treatment. Only suitable where the condition has not progressed for at least a year.

Camouflage

Medical camouflage products match skin tone and last through the day. For exposed sites they make a substantial difference to daily life while slower treatment continues, and they are worth discussing rather than treating as giving up.

What else it could be

These are the conditions this is most often mistaken for. Treating the wrong one is the commonest reason a problem drags on for months.

Often mistaken for	How it's told apart
Pityriasis versicolor	Pale patches with fine scale on the chest and back, caused by a yeast. Scrapes positive, clears with antifungal treatment.
Pityriasis alba	Faint pale patches on children's cheeks, with slight scale. Related to eczema, and it resolves on its own.
Post-inflammatory hypopigmentation	Pale skin left behind after a rash, burn or injury. Repigments by itself over months.
Leprosy	A pale patch with loss of sensation and sometimes a thickened nerve. This distinction matters, and it is made by testing sensation — vitiligo patches feel normal.
Nevus depigmentosus	Present from birth or early childhood, stable in size and shape, and does not spread.

Common questions

Is vitiligo caused by eating fish with milk?

No. This belief is widespread in India and has no basis. Vitiligo is an autoimmune condition in which the body's own immune system destroys pigment cells. No food combination causes it, and no diet cures it.

Is it the same as leprosy?

No, and the confusion causes real social harm. Leprosy patches lose sensation; vitiligo patches feel entirely normal. Testing sensation in the patch distinguishes them at the first examination.

Can colour come back?

Often, partially, and it depends heavily on site and duration. Face and neck respond best. Patches over the hands, feet and lips respond least. Recently developed patches do better than ones present for years. Treatment is realistically about repigmenting what can be repigmented and stopping further spread.

Will it spread?

It may. Some people have a few stable patches for decades, others see gradual spread. Treatment aimed at halting progression is often as valuable as treatment aimed at restoring colour, and it is more reliably achieved.

Is surgery an option?

For stable disease that has not changed for a year or more and has not responded to medical treatment, yes. Melanocyte transfer and split-thickness grafting can repigment selected areas. Stability is the precondition — operating on active vitiligo does not work.

This page is general information and does not replace a consultation. Whether any treatment described here is right for you depends on examination, history and other medicines, and that assessment needs a doctor.