The medical term for skin losing its pigment is hypopigmentation, and the most common condition that causes it is vitiligo. But several other conditions can also make skin lose color, from fungal infections to genetic disorders like albinism. Which one applies depends on how the color loss looks, where it appears, and whether it’s temporary or permanent.
Vitiligo: The Most Common Cause
Vitiligo is an autoimmune disease where the body’s immune system mistakenly attacks and destroys the cells that produce skin pigment. It affects roughly 0.4% of people worldwide, and males and females are equally affected. The condition creates smooth, white patches with clearly defined edges, most often on the face, hands, arms, and around joints. These patches don’t itch, flake, or change the texture of your skin. The only change is the loss of color.
What happens biologically is a destructive cycle. Certain immune cells that normally fight infections instead begin targeting pigment-producing cells in the skin. Once they attack, they release chemical signals that recruit even more immune cells to the area. This chain reaction destroys more and more pigment cells, and the white patches gradually expand.
Vitiligo comes in two main forms. Non-segmental vitiligo, the more common type, tends to appear symmetrically on both sides of the body and can reactivate even after long periods of stability. Segmental vitiligo affects only one area or side of the body and typically stabilizes within about two years, after which new patches rarely appear.
People with vitiligo have a higher chance of developing other autoimmune conditions. A large 10-year study of over 3,200 patients found that roughly 23% had at least one additional autoimmune disorder. Thyroid disease is the most common, but the list also includes rheumatoid arthritis, type 1 diabetes, inflammatory bowel disease, pernicious anemia, Addison’s disease, and alopecia areata (patchy hair loss). Depression and anxiety are also frequently reported, largely because of the visible nature of the condition.
Albinism: Pigment Loss From Birth
While vitiligo develops over time, albinism is a genetic condition present from birth. People with albinism produce very little or no pigment at all, affecting their skin, hair, and eyes. The most recognized form, oculocutaneous albinism, has four known types, each caused by mutations in a different gene involved in pigment production. All four types are inherited in an autosomal recessive pattern, meaning a child must receive one copy of the mutated gene from each parent.
The most severe form, type 1A, completely eliminates pigment production, resulting in very white skin, white hair, and light-colored eyes with significant vision problems. Type 1B allows some pigment to accumulate over time, so people with this form may gradually develop slightly darker hair or skin as they age. Types 2, 3, and 4 vary in severity and are more common in certain populations. Type 2, for instance, affects roughly 1 in 3,900 to 10,000 people of African descent, compared to about 1 in 36,000 white Europeans.
Temporary Causes of Pigment Loss
Not all pigment loss is permanent. Several conditions cause temporary lightening that resolves on its own.
Post-inflammatory hypopigmentation happens after your skin heals from an injury, burn, or inflammatory condition like eczema or psoriasis. The affected area looks lighter than the surrounding skin because the healing process temporarily disrupts pigment production. In most cases, your skin cells start making pigment again as the area heals, and normal color returns within a few weeks to a few months without treatment.
Pityriasis alba, common in children and teenagers, causes pale, slightly scaly patches that usually show up on the face. It’s closely related to dry skin and mild eczema, and it resolves on its own over time.
Fungal Infections That Mimic Pigment Loss
Tinea versicolor is a fungal skin infection that’s frequently confused with vitiligo, but the two look and feel quite different. Tinea versicolor causes small, scaly patches that may appear lighter or darker than your normal skin tone. These patches typically show up on the chest, back, neck, and upper arms, and they often itch, especially in warm or humid weather. The skin in affected areas tends to feel dry or flaky.
Vitiligo patches, by contrast, are completely smooth, stark white, and painless. They have sharp, well-defined borders and don’t flake or itch. If you’re noticing light patches that are scaly or itchy, a fungal infection is more likely than vitiligo, and it’s treatable with antifungal medication.
How Pigment Loss Is Diagnosed
Dermatologists often use a tool called a Wood’s lamp, which emits ultraviolet light, to evaluate patches of discolored skin. Under this light, skin that has completely lost its pigment (as in vitiligo) glows a bright blue-white with sharp borders. Skin that has only partially lost pigment appears as a duller, off-white glow. This distinction helps separate vitiligo from conditions like nevus depigmentosus (a birthmark with reduced but not absent pigment) or the pale patches seen in tuberous sclerosis.
The Wood’s lamp is especially useful for people with lighter skin tones, where patches of pigment loss can be nearly invisible to the naked eye. The UV light amplifies subtle color differences that would otherwise go unnoticed.
Treatment Options for Vitiligo
There is no cure for vitiligo, but treatments can slow its progression and help restore color to affected areas. In 2022, the FDA approved a topical cream containing a type of drug called a JAK inhibitor for people 12 and older with non-segmental vitiligo. In clinical trials, 30% of patients who used the cream twice daily achieved at least 75% improvement in facial pigment scores after 24 weeks, compared to 10% of those using a placebo. The cream is applied to affected areas covering up to 10% of the body’s surface.
Other treatment approaches include light therapy, which uses controlled UV exposure to stimulate pigment cells, and topical corticosteroids, which suppress the immune response that’s attacking those cells. For stable vitiligo that hasn’t spread in a long time, surgical options like skin grafting can transplant healthy pigment cells to depigmented areas. The best approach depends on how widespread the vitiligo is, whether it’s still active, and which areas of the body are involved.