Vitiligo (Safaid Daagh): Causes, Myths and Treatment

Pale patches appear on the hands, face or around the mouth, and slowly spread. For many people, especially those with darker skin tones, the emotional burden of vitiligo is heavier than the physical one. There is a lot of myth around it in our society: that it is contagious, that it is caused by eating fish with milk, or that it is a punishment. None of that is true, and treatment today is better than most people think.

What is vitiligo?

Vitiligo (safaid daagh) is a long-term skin condition in which the cells that make skin colour, called melanocytes, are destroyed, leaving white or pale patches. It affects about 1 in 100 people, of all skin types and both sexes, and often begins before the age of 30.

Is it contagious? What causes it?

It is not contagious. You cannot catch it by touching, sharing food or living with someone with vitiligo. In most people it is an autoimmune disease, where the body’s immune system attacks its own pigment cells. It sometimes runs in families, and may be linked with other autoimmune conditions such as thyroid disease (hypothyroidism or hyperthyroidism), type 1 diabetes, and alopecia areata. Stress, sunburn or skin injury can trigger new patches in some people. Diet does not cause it, and combining milk with fish or sour foods is a myth.

How does it look?

• Milk-white, well-defined patches, usually painless and without itching
• Common on hands, feet, face (around eyes and mouth), elbows, knees and genitals
• Patches on both sides of the body (symmetrical) in the most common type
• Hair in the patch may turn white
• Patches may stay small or grow over months and years, and may stay stable for long periods

Is it vitiligo or something else?

Other conditions can cause pale patches, including a fungal infection like tinea versicolor (see ringworm), leprosy, eczema marks and post-inflammation lightening (see eczema), and nutritional causes. A dermatologist can usually tell by looking, sometimes using a special lamp (Wood’s lamp). Blood tests for thyroid and sugar may be advised.

Treatment: what actually works

Vitiligo cannot yet be fully cured for everyone, but patches can often be stopped from spreading and repigmented. The earlier it is started, the better it works.

• Topical steroid creams for limited patches, used for a limited time under supervision since long use thins the skin.
• Calcineurin inhibitors such as tacrolimus ointment, suitable for the face, neck and skin folds.
• Phototherapy (narrowband UVB) a few times a week for widespread vitiligo. It is among the most effective options, but needs patience, often several months.
• Newer treatments: JAK-inhibitor creams and excimer laser are available in some centres.
• Surgery (skin or melanocyte grafts) for stable patches that have not responded.
• Camouflage: waterproof make-up and self-tanning products can help patches blend in. Some people choose to depigment remaining skin in extensive disease, a decision to be taken with a specialist.

Protect your skin

• Patches have no pigment protection, so they burn easily. Use a broad-spectrum sunscreen on exposed patches, and wear hats and long sleeves.
• Avoid injuring and scratching skin, which can trigger new patches.
• Stay away from “vitiligo cures” sold online, in hakeem clinics or through herbal ointments. Many contain strong steroids, or products that irritate and worsen the skin.

The emotional side

Vitiligo can affect confidence, relationships and, in our society, even marriage prospects. Feeling low or anxious about it is understandable and not a weakness. Talk to family, join a support group, and if sadness or worry becomes overwhelming, speak to a doctor or counsellor (see depression and anxiety).

When to see a dermatologist

• As soon as you notice new white patches, especially if spreading
• Patches on the face, hands or genitals
• Patches that are itchy, scaly, numb, or painful, which may be another condition
• Symptoms of thyroid disease such as weight changes, tiredness or palpitations
• Mood changes because of the skin

Key takeaways

• Vitiligo is an autoimmune skin condition. It is not contagious, not a punishment and not caused by food.
• Early treatment can stop spread and bring back colour in many people.
• Sunscreen is essential. Avoid untested herbal and steroid-laced creams.
• Look after your emotional health and consider thyroid testing.

Related products on Medimart

• Tacrolimus: an ointment prescribed for vitiligo on sensitive areas
• Triamcinolone: a steroid prescribed for short-term use on selected skin areas

Browse sunscreens and moisturizers and creams on Medimart, delivered across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor.